The Laryngoscope
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To examine the etiology, presentation, and management of temporal bone fractures in children. ⋯ Pediatric temporal bone fractures are associated with falls and motor vehicle accidents. There is a high incidence of associated intracranial injuries and hearing loss, but facial nerve injuries are uncommon. Timely management minimizes complications.
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We have studied spiral ganglion cell (SGC) survival and soma size in neonatally pharmacologically deafened kittens. They were implanted with a four-electrode array in the left cochlea at 100 to 180 or more days of age. Eight animals were chronically stimulated approximately 1000 hours over approximately 60 days with charge-balanced, biphasic current pulses; three were unstimulated controls. ⋯ There was no evidence of an effect of electrical stimulation on SGC survival under this protocol and with this duration. On the other hand, the cell size on the stimulated side was significantly larger than the control side in the middle segment (4 to 8 mm from the basal end). SGCs undergo a reduction in size after prolonged auditory deprivation; however, these changes may be partially moderated after chronic intracochlear electrical stimulation.
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A technique for indirect laryngeal color photography for the office or clinic using rigid rod-lens angled telescopes is outlined. The photographic equipment can be used for documentation at both direct and indirect laryngoscopy except that the latter requires purpose-designed 70 degrees or 90 degrees telescopes. The method, which requires practice and patience, and the equipment are described in detail, and the difficulties and frustrations that are encountered are discussed.
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The detection and management of submandibular metastases are fundamental to the treatment of oral carcinoma. Detailed investigation of submandibular lymphatic anatomy and subsite predilection for metastases, as well as a comprehensive method for submandibular space dissection, have been lacking. This thesis explores submandibular lymphatic anatomy through a review of the literature and cadaver dissections. ⋯ Overall, 39% of patients manifested submandibular disease. The majority of submandibular metastases in this study measured 1 cm or less and most commonly involved the perivascular (primarily prevascular) nodes followed by the preglandular and, previously ill-defined, deep nodes. These findings are discussed with regard to the rationale for currently used neck dissections.
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Randomized Controlled Trial Clinical Trial
Tube placement: a prospective, randomized double-blind study.
Bilateral myringotomy with tympanostomy tube placement is the second most frequently performed pediatric surgical procedure, next to circumcision. Postoperative pain relief for children undergoing this procedure has been an ongoing concern. The authors undertook a prospective, randomized, double-blind, placebo-controlled clinical study in 200 consecutive children to investigate the efficacy of oral acetaminophen, acetaminophen with codeine, ibuprofen, and placebo administered preoperatively in relieving postoperative pain in children undergoing this procedure. ⋯ There was no significant difference in postoperative pain score between the four groups (P > 0.4447). Thus it is likely that the intraoperative administration of antibiotic eardrops mixed with 4% lidocaine is all that is required to alleviate postoperative pain in children undergoing myringotomy with tympanostomy tube placement. Preoperative oral analgesics are apparently of little added benefit.