Contemporary surgical management of high cervical metastases: an anatomic approach.
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Head and Neck Neoplasms↗
Biomedical subjects
M L Pensak
Publications and source records attributed to M L Pensak.
Neural choristoma of the middle ear.
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Brain↗
Fundamentals of magnetic resonance imaging.
Recent advances in diagnostic imaging have accounted in part for the early detection of space occupying lesions in and around the temporal bone. To appreciate fully the modality of nuclear magnetic resonance imaging, the physician must understand the limitations and potential applications for this newest of radiologic studies. This update introduces the otologist to the language and principles of magnetic resonance imaging scanning.
Humans↗
Acoustic reflex dynamics and auditory brain stem responses in multiple sclerosis.
Onset latency, rise time, and amplitude measures of the acoustic reflex and auditory brain stem responses (ABRs) to clicks were elicited from normal subjects and subjects with multiple sclerosis (MS). The results indicated that MS subjects exhibited response abnormalities including prolonged rise times of the acoustic reflex and prolonged absolute latencies, interwave latencies and interaural latencies, and poor response stability of the ABR. The results of this study indicate that measurement of acoustic reflex dynamics can add to the diagnostic value of the test beyond measurement of acoustic reflex threshold and decay. The combination of complete acoustic reflex and ABR tests is a valuable contribution to the diagnosis of patients with MS who have no auditory symptoms.
Adult↗
Cerebellopontine angle lipomas.
Lipomas of the intracranial vault are uncommon lesions. Rarely, lipomas of the cerebellopontine angle have been identified. The two cases of cerebellopontine angle lipomas reported herein brings the number of recorded cases to 13.
Brain Stem↗
Facial reanimation with the VII-XII anastomosis: analysis of the functional and psychologic results.
The VII-XII anastomosis has been employed for more than a decade by The Otology Group, P.C., in the facial reanimation of patients undergoing extirpation of tumors involving the cerebellopontine angle and the skull base. A retrospective review based upon a detailed questionnaire and submitted photographic documentation from 61 patients forms the basis for this review. Details and analysis of the functional results include onset of function, synkinetic activity, corneal irritation and associated ophthalmologic problems, facial tone and symmetry, and volitional mimetic function. From a psychosocial perspective, evaluation was made regarding workplace and home acceptance, self consciousness, adaptation, and overall satisfaction. Because of the nature of its technical performance and reliability, the VII-XII anastomosis is an important technique for the otolaryngologist to be familiar with. Cognizance of the functional and psychologic results with this procedure will ensure optimal (yet realistic) rehabilitation for this patient population.
Adaptation, Psychological↗
Skull-base surgery: operative refinements.
Advances in microsurgical techniques, with the use of the laser and the ultrasonic suction aspirator, have paved the way for even more aggressive surgical approaches to large skull-base lesions, such as glomus tumors, adenocarcinomas of the temporal bone, and cranial nerve neuromas. Postoperative morbidity of multiple cranial nerve dysfunction has been aggravated in the past by cerebrospinal fluid leakage and/or gastro-intestinal dysfunction. At the Otology Group, P.C., in the course of dealing with more than 86 skull-base tumors, we have developed a standardized, multispecialty approach to such extensive skull-base lesions, including tracheotomy, gastrostomy, "ventriculoatrial" shunt placement, and rotated temporalis muscle flap closure. This article presents cases that illustrate the evolution of the current, "standard skull-base" operative procedure and the rationale for incorporation of the shunt and the muscle flap closure as operative refinements. Their beneficial effects upon postoperative morbidity are detailed.
Adolescent↗
Perioperative evaluation and care of patients with lesions involving the skull base.
Within the past quarter of a century, contributions to the surgical literature have steadily reflected an increasing interest in the surgical extirpation of lesions involving the skull base. While optimistic reports demonstrate a variety of operative techniques and clinical experiences, there has been a paucity of discussion regarding the intraoperative and perioperative management of these complex cases. Cognizant of the fact that the care of these patients is of paramount importance, we herein review our rationale and practiced protocol for management of this unique patient population. The removal of lesions that also require the sacrifice of multiple cranial nerves results in significant postoperative morbidity. With the significant cardiopulmonary challenges attendant upon long procedures, these patients require constant multisystem Infection surveillance, wound care, cardiopulmonary support, fluid and nutritional monitoring, vocal and pharyngeal rehabilitation, along with psychological support, manifest in a complicated array of managerial decisions, require an organized approach to optimize patient care.
Adolescent↗
Primary adenocarcinoma of the temporal bone with posterior fossa extension: case report.
Primary adenomatous tumors of the middle ear and mastoid are rare. We recently cared for a man with a far-advanced primary adenocarcinoma of the middle ear and mastoid. Complete tumor removal was accomplished by a modified infratemporal fossa approach and was supplemented with postoperative radiation therapy. The postoperative complications of aspiration pneumonia and cerebrospinal fluid (CSF) leakage through the wound stimulated subsequent incorporation of temporary gastrostomy and CSF shunting into our surgical procedure. Now, 23 months after surgery, the patient is without evidence of recurrent disease. His case illustrates our approach to the management of such extensive temporal bone lesions as well as some of the potential problems which may be encountered.
Adenocarcinoma↗
Acquired immunodeficiency syndrome (AIDS).
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Acquired Immunodeficiency Syndrome↗
Diabetes mellitus: current concepts.
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Diabetes Mellitus↗
Postoperative deep venous thrombosis and pulmonary embolism: diagnosis, management, and prevention.
With the application of new surgical approaches and more extensive neurotologic procedures, the length of surgery may be prolonged and patients are often immobilized for extended periods. Statistics indicate that as many as 40% of patients over the age of 40 operated on for more than an hour will develop a deep venous thrombosis; the risk of fatal pulmonary embolus then becomes 37%. It becomes very clear that to assume proper care of their patients, surgeons must not only be cognizant of the diagnosis and management of these complications, but also be aware of those patients at risk, and the effective methods of prevention. The present article discusses the diagnosis and treatment of deep venous thrombosis and pulmonary embolism, and the steps that may be taken to prevent their occurrence postoperatively.
Adult↗
Lyme disease. A cause of bilateral facial paralysis.
Recently we had the opportunity of treating a boy from the northeastern region of the United States in whom bilateral facial palsies developed. After obtaining a detailed history and performing a thorough physical examination, the findings suggested Lyme disease. We herein discuss our evaluation and treatment of this child as well as review the otolaryngologic manifestations of this rare disease.
Anti-Bacterial Agents↗
Sudden hearing loss and cerebellopontine angle tumors.
Lesions of the cerebellopontine angle may cause a sudden hearing loss. To illustrate and reaffirm the importance of a thorough neurotologic evaluation we performed a retrospective review of the audiologic and clinical data available on 506 patients with proven lesions of the cerebellopontine angle. Seventy-seven patients (15.2%) were found to have a history commensurate with sudden hearing loss. We reviewed the relevant audiologic data as well as the clinical circumstances of this select patient population.
Adult↗
Surgery and the patient with heart disease.
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Anesthesia, General↗
Tympanic membrane photography: historical perspective.
When viewed in a broad perspective, photographic documentation of the tympanic membrane, both in the normal and pathologic state, has enabled otologists to better understand many disease processes in the ear. Furthermore, good reproductions have served as invaluable aids in teaching both physicians and students as well as permitting better understanding of pathologic conditions for which patients may need therapeutic intervention. This review traces the development over the last century of tympanic membrane photography, reflecting advances made in both the art and science of otologic photography.
History, 19th Century↗