Dermatopathic lymphadenopathy presenting as a parotid mass.
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Diagnosis, Differential↗
Biomedical subjects
C K Anonsen
Publications and source records attributed to C K Anonsen.
Laryngeal brainstem evoked response: a developmental study.
A developmentally receding laryngeal chemoreflex (LCR) has been described in infant animals of several species characterized by vocal cord adduction in response to laryngeal stimulation as well as a potentially fatal cardio-respiratory response. Age-related differences in the brainstem respiratory centers may account for differences in the LCR and play a role in such disorders as Sudden Infant Death Syndrome (SIDS) and infant apnea. Study of the LCR at the brainstem level could provide insights into normal maturation of respiratory centers and eventually the pathophysiology of these disorders. The present study evaluated the laryngeal brainstem response (LBR) evoked by electrical stimulation of the superior laryngeal nerve in kittens using a far-field technique similar to auditory brainstem response testing. Recordings were obtained via posterior pharyngeal and posterior cervical recording sites and compared to results previously obtained in our laboratory for adult cats. The LBR in kittens demonstrated differences in threshold, latencies, and morphology which suggests that postnatal maturation of laryngeal function at the brainstem level does occur.
Aging↗
Alveolar soft part sarcoma of the head and neck. A disease of children and young adults.
Alveolar soft part sarcoma (ASPS) is a rare malignancy of uncertain histologic origin that predominantly afflicts female children and young adults. Forty-three cases occurring in the head and neck have been identified, to which we add a case. The most frequent sites of occurrence in the head and neck are orbit and tongue. Treatment is universally surgical, with limited roles for adjuvant radiotherapy and chemotherapy. Representative populations of patients with orbital, non-orbital and extremity ASPS are compared statistically. Improved disease-free intervals in orbital ASPS vs non-orbital ASPS and head and neck ASPS vs extremity ASPS are documented. Debate exists regarding the histologic origin of ASPS. The additional case presented does not corroborate recent immunohistochemical studies suggesting myogenic origin. Nevertheless, the clinical pattern of disease offers additional support to the myogenic hypothesis of histologic origin.
Adolescent↗
Laryngeal brain stem evoked response.
Sensory stimuli to the larynx evoke a laryngeal adductor reflex mediated by the brain stem via superior and recurrent laryngeal nerves. Aberrant laryngeal reflexes have been proposed to explain a number of poorly understood disorders, including "reflex apnea," idiopathic laryngospasm, and sudden infant death syndrome. The purpose of the present study was to evaluate far field brain stem recordings following stimulation of the superior laryngeal nerve to determine whether laryngeal brain stem response is a valid measure of laryngeal activity at the brain stem level. The nerve was stimulated electrically in adult cats, and the resultant laryngeal adductor response as well as far field brain stem activity was recorded. For the latter, six reproducible positive and five reproducible negative waves were obtained via posterior pharyngeal (+) and posterior cervical (-) recording electrodes. Response threshold and latencies were measured and evaluated as a function of stimulus parameters. Wave latencies corresponded closely to those reported in prior near and far field evoked response recordings.
Animals↗
Langerhans' cell histiocytosis of the head and neck.
Langerhans' cell histiocytosis has been accepted by many to replace the term Histiocytosis X, describing a poorly defined continuum of diseases involving neoplastic proliferation of histiocytes. Twenty-four cases of histologically confirmed Langerhans' cell histiocytosis with head and neck involvement were seen between the years 1970 to 1986, and charts were reviewed retrospectively. Control of local osseous disease was successful using radiation therapy in 100% of those cases with follow-up. Surgical curettage of bone lesions was successful in a small number of cases. Chemotherapy alone or in combination with radiation appeared to enhance survival in patients with recurrent disease or multisystem involvement. Sixteen of the 24 patients (67%) are disease free with a mean follow-up of 6 years. Prompt diagnosis and careful follow-up are important to improve survival and prevent complications.
Adolescent↗
Cranial bone grafts for post-traumatic facial defects.
Recent interest in onlay cranial bone grafts has shown it to be a preferred technique in the reconstruction of facial defects. This paper reports seven patients in whom outer table cranial bone grafts were used to reconstruct post-traumatic facial deformities. These included orbital and zygomatic deformities (2 patients), maxillary defects (2 patients), mandibular defects (2 patients), and nasal deformity (1 patient). A brief review of the development of membranous bone grafting for maxillofacial reconstruction is given. Good cosmetic results were obtained in six of seven patients with no evidence of graft resorption. One patient required removal of the graft because of inadequate soft tissue coverage. No patient suffered any significant donor site morbidity. In summary, this technique is extremely useful in treating post-traumatic bony deformities of the facial skeleton. The excellent graft survival and ease in harvesting the graft make this technique preferable to traditional endochondral grafts taken from the iliac crest and rib.
Adult↗
Pyoderma gangrenosum of the head and neck.
Pyoderma gangrenosum is an ulcerative skin disorder usually associated with an underlying systemic disease. Head and neck involvement is rare, but possibly more common than once thought. The etiology of this disease is unclear, but may be related to an abnormal immunologic response. There are no pathognomonic histologic or laboratory findings; the diagnosis is made by the clinical appearance of the lesions and disease course. Treatment consists of immunosuppression and local wound care in addition to a search for and treatment of an underlying primary systemic disorder. A case report and review of the literature is presented with discussion of common head and neck manifestations, the differential diagnosis, and treatment alternatives.
Adult↗
Assessment of facial reinnervation by use of chronic electromyographic monitoring.
The study of muscle reinnervation has been difficult because of lack of an accurate, reproducible method to monitor return of function. Visual assessment relies on subjective interpretation. Histology provides anatomic, not functional, information. Electromyography and anatomic tracing have been most effective in evaluating physiologic return of muscle function. It has been difficult to assess the timing of functional return electromyographically because measurements are intermittent and electrode placement varies. A method was designed to allow long-term monitoring of electromyographic (EMG) activity in the facial musculature of the rabbit. Sixteen rabbits were monitored for at least 1 month or until return of normal EMG activity was identified. Various levels of injury (nerve crush, transection without repair, and transection with immediate end-to-end anastomosis) were evaluated. EMG evidence of reinnervation was seen in all animals with nerve crush injuries as well as those with anastomoses. Physiologic continuity of the nerves was then evaluated by retrograde transport of horseradish peroxidase. All muscles showing return of EMG activity had uptake of HRP into the appropriate brain stem motor neurons. The denervated muscles showed no HRP uptake. The information gained in this study shows potential for use of this technique in comparing functional return of muscle activity between different reinnervation methods.
Animals↗
Preliminary observations after facial rehabilitation with the ansa hypoglossi pedicle transfer.
Facial paralysis is a very disabling condition, both functionally and cosmetically. Despite the different methods of facial reanimation that have been described, there is no single method that will restore normal facial tone and motion. Of the methods available, primary neurorrhaphy is probably the most effective. The recovery period, however, is prolonged and, as a result, muscle tone and bulk may be lost. The hypoglossal-facial anastomosis is also a very reliable and effective technique but requires necessary interruption of both major cranial nerve trunks. Transfer of a neuromuscular pedicle (based on the ansa hypoglossi) has been offered as a method of facial reanimation that involves neither prolonged recovery nor interruption of the major cranial nerve functions. The application of this technique for reinnervation of a paralyzed larynx was first described by Tucker in 1970, and the technique was applied to facial muscle (in animal models) in 1977. The effectiveness of this technique--and its application in the management of facial paralysis in the human patient--remains controversial. We report our experience with a series of six patients who underwent neuromuscular pedicle transfer in conjunction with other more conventional methods of facial reanimation. The function of the pedicle and its contribution to the overall facial rehabilitation were assessed clinically and electromyographically. Factors influencing the success of the procedure and clinical and experimental evidence to support its application are discussed. While our experience with this technique is limited, it would appear that the neuromuscular pedicle transfer may play a useful adjunctive role in reanimation of the face in selective cases of facial paralysis.
Adult↗
Reinnervation of skeletal muscle with a neuromuscular pedicle.
In the past decade the otolaryngologist has become interested in the problem of muscle reinnervation as it relates to laryngeal and facial paralysis. Although reinnervation by neuromuscular pedicle transfer has shown promising results in the laboratory and clinic, some investigators have had difficulty in achieving reliable results with this procedure. To further assess the technique's validity, we investigated the neuromuscular pedicle. This study utilized a strap muscle neuromuscular pedicle transfer to a contralateral strap muscle in the rabbit. The results were analyzed by the use of a number of independent measures, including electrical stimulation of the nerve, muscle contractibility, electromyography, enzyme histochemistry, reduced-silver staining for normal fibers, and the retrograde transport of the enzyme marker horseradish peroxidase. The physiologic and anatomic results demonstrated that morphologic and functional reinnervation of the experimentally isolated muscle by the transferred neuromuscular pedicle occurred. The most convincing data were produced by gross electrical stimulation, twitch and tetanic contraction, and horseradish peroxidase labeling. Electromyographic activity and other histologic findings supported the above conclusions.
Animals↗
Acquired laryngomalacia secondary to obstructive adenotonsillar hypertrophy.
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Adenoidectomy↗