William G. Hemenway

VII Rhinocerebral and Otologic Mucormycosis

CASE 1. DVAH #503-28-91-52 entered the Denver Veterans Administration Hospital in October, 1968 with a ten-day history of swelling, diplopia and considerable loss of vision in the right eye. The patient had been a known diabetic for four years. Disregarding his physicians advice, he had discontinued his insulin several months previously. Past history was negative for ocular, nasal or sinus disease. His family had noted personality changes of irritability and hostility in the weeks preceding admission.

Jacobson's neurectomy for frey's syndrome

Summary A case of gustatory sweating after superfical parotidectomy is presented. The patient received symptomatic relief from Jacobsons neurectomy. The therapeutic measures which have been described for Freys syndrome are reviewed, and one, Jacobsons neurectomy, is discussed in detail with regard to the rationale for the procedure, surgical technic, and the results of therapy. The operation is easily performed by those experienced in microsurgery of the ear and does not carry the risk of serious complications or undesirable side effects. A review of the cases of Freys syndrome treated by this method revealed that 90.9 per cent had a satisfactory postoperative result. We consider Jacobsons neurectomy the procedure of choice for symptomatic gustatory sweating.

Spatial Distribution of Vestibular Nerve in Internal Auditory Canal

Although neuroanatomical pathways of the vestibular system have recently become more clarified, detailed anatomical information regarding the innervation of smaller areas of the vestibular end-organs has been incomplete. It is important to determine the precise relationships of the vestibular nerve fibers in the internal auditory canal for correlation with neurophysiological studics. The present study was designed to plot the course of vestibular nerve fibers by mapping out the spatial distribution of the afferent vestibular nerves in the internal auditory canal from each of the vestibular end-organs.

Temporal bone pathology following maternal rubella.

ZusammenfassungBei einem 4 Monate alten Kind mit serologischem Nachweis für Rötelnembryopathie und positiver Viruskultur werden die histologischen Veränderungen des Felsenbeins beschrieben und diskutiert. Die primären Schäden waren bei diesem Fall in der Stria vascularis, in der Membrana tectoria, in den Haarzellen des Cortischen Organs und im Sacculus lokalisiert. Sie waren ähnlich der sog. Cochleo-sacculären Degeneration vom Typ Scheibe und entsprachen auch den Veränderungen, wie sie bei postnatalen Masern beschrieben worden sind.Darüber hinaus worden folgende pathologischen Befunde bei diesem Fall beobachtet:1.Eine typische Verteilung von Haarzelldegenerationen in der Cochlea.2.Eosinophiles Material in den Perilymphräumen, meist offenbar als Ausschwitzung von den Gefäßen der Scala tympani.3.Formveränderung der zweiten Schneckenwindung und des Rosenthalschen Kanals und4.Anomalie des Steigbügels.SummaryThe histopathological abnormalities in the temporal bone of a four-month-old infant with positive virus culture and serological data for maternal rubella are presented and discussed.The primary abnormalities of this case were located in the stria vascularis, tectorial membrane, hair cells in Cortis organ and the Sacculus, and similar to the so-called cochleo-saccular degeneration of Scheibe and also those observed in postnatal measles.Additional pathological findings observed in this case were:1.the specific distribution of the severely-degenerated hair cells in the cochlea,2.the eosinophilic material in the perilymphatic space most likely coming from vessels in the scala tympani,3.the slight distortion of the cochlear second turn and Rosenthals canal, and4.the stapes anomalies.

Cochlear otosclerosis: a human temporal bone report.

Several reports have appeared in the literature with regard to sensorineural hearing loss in otosclerosis. Many of these studies have included a description of the otosclerotic process which has produced inner ear changes thought to be related to a sensorineural deafness. At this time there does not appear to be unanimity of opinion as to the relationship between the otosclerotic process and the sensorineural deafness. Several proposals have been advanced which will be discussed in relation to the following case report. REPORT OF CASE

Pathological changes in congenital deafness.

The temporal bones of four infants with varying systemic and ear pathologies are described and discussed with reference to the probable effect on hearing and embryogenesis.

The Sequential Bithermal Binaural Caloric Test: I. A Statistical Analysis of Normal Subject Responses

Statistical analysis of bithermal binaural caloric test results gave a statistically significant response difference between ears for right-handed normal subjects. There were no significant response differences due to temperature of stimulation or due to the interaction between temperature of stimulation and ear stimulated. Of the four different orders of stimulation tested, all were statistically equivalent. Because intrasubject variance from a statistical analysis of normal subject responses was evidently much smaller than percentage based variance, the use of absolute differences or confidence intervals for determination of normal limits should yield more precise normal criteria than percentage based comparisons allow.

Role of Periosteum on the Fate of Pedicle Osteocutaneous Grafts

Recent studies on the fate of pedicle osteocutaneous grafts have shown that they remain viable and may be actively involved in the mechanics of bone repair. This communication reports on a series of experiments aimed to clarify the role of periosteum in the survival of pedicle-assisted bone grafts. Osteocutaneous grafts were developed in dogs in such a manner as to isolate the implant from normal recipient bone. Free bone grafts were used as controls and a group of pedicle periosteal grafts were studied as potential sources of bone formation. Specimens were evaluated at regular intervals over a 40-week period. The pedicle bone grafts maintained their viability and developed vigorous osteoneogenesis. The process was progressive and eventually resulted in partial substitution of the original graft by new bone of periosteal origin. The free bone grafts were resorbed and no bone formation was obtained in pedicle periosteum specimens. The study provides clear evidence that under experimental conditions no bone contact is needed to maintain the viability of pedicle osteocutaneous grafts. It also shows that the periosteum has the leading role in the restructuring process of these grafts.

The Sequential Bithermal Binaural Caloric Test: II. Clinical Application of New Statistical Methods for Interpretation

Three tests for the determination of caloric nystagmus response abnormalities have been developed, based upon analysis of intrasubject normal responses, obtained by using a statistical model that provided an exact fit with clinical procedures. Normal limits derived from interaural, stimulus temperature, and nystagmus direction responses should provide a more sensitive index of abnormality than limits based on percentage based response criteria. A retrospective examination of caloric responses from Ménières disease patients provided preliminary support for clinical feasibility and increased sensitivity of the statistical methods advocated for clinical usage.

Prehistoric Trephination of the Frontal Sinus

Two examples of prehistoric trephination of the frontal sinus are presented. Both specimens were collected in Peru during the second decade of this century and are currently preserved at the Museum of Man in San Diego. One of the skulls represents trephining by incision and the other by scraping. Both show signs of healing indicating that the operated individuals survived the procedure. No definite clues as to the indications for surgery were found in one of the specimens. Trauma involving the frontal sinus appears to have been the reason for trephination in the other.