Cervical necrotizing fasciitis is a rare but life-threatening soft tissue infection primarily affecting the superficial and deep fascial planes. If proper treatment is delayed, the infection may cause extensive necrosis of overlying skin, destroying fascia, adipose tissue and muscle and producing severe systemic toxicity. So the key to the successful outcome is early recognition and rapid initiation of definitive radical debridement. The authors report, along with a literature review, one case of necrotizing fasciitis spreading into the anterior chest wall.
Adipose Tissue ; Debridement ; Fascia ; Fasciitis, Necrotizing ; Muscles ; Necrosis ; Skin ; Soft Tissue Infections ; Thoracic Wall ; Thorax

Obstructive sleep apnea is a manifestation of upper airway instability leading to upper airway collapse during sleep. Current diagnostic testing with polysomnography provides information regarding the number of apneas and hypopneas but does not provide any information regarding the level of pharyngeal narrowing or collapse. The identification of the site of obstruction is essential in choosing the appropriate treatment, especially when surgical intervention is considered. In this review we present contemporary methods for localizing obstructive sites with emphasis on two promising airway evaluation modalities. Sleep videofluoroscopy and sleep en-doscopy. Further understanding of the obstructive events occurring during sleep with precise evaluation of the sites of obstruction will eventually guide tailored surgical treatment with improved surgical outcomes.
Apnea ; Diagnostic Tests, Routine ; Endoscopy ; Humans ; Polysomnography ; Sleep Apnea, Obstructive ; Snoring

BACKGROUND AND OBJECTIVES: Facial sequelae after facial paralysis cause serious functional and aesthetical problems including facial asymmetry, symkinesis and facial crease. The most common aesthetical problem is facial furrow and crease induced by facial hyperkinestic movement due to incomplete facial recovery. The aim of this study is to investigate the efficacy of botulinum toxin A injection in patients with deep nasolabial fold and bitterness furrow after facial paralysis. SUBJECTS AND METHOD: Thirty-five patients who recovered partially from facial paralysis, had deep nasolabial fold and bitterness furrow with or without facial asymmetry. Botulinum toxin A intramuscular injection on perioral area for mouth corner deviation, subcutaneous injection on deepen nasolabial fold, and intramuscular injection on bitterness furrows had improved lower facial symmetry and cosmetic configuration without Pseudo Bell's palsy. RESULTS: Of 26 patients who had facial palsy side nasolabial fold before the injection, 21 patients improved. Of the 21 patients who had facial palsy side bitterness furrow, 16 patients improved after the injection. Of 11 patients who had contralateral nasolabial fold, 4 patients improved after the injection. Of 13 patients who had contralateral bitterness furrow, 7 patients improved after the injection. CONCLUSION: After botulinum toxin A injection, the patients showed marked improvement of nasolabial fold, bitterness furrow and lower facial asymmetry.
Botulinum Toxins ; Botulinum Toxins, Type A ; Cosmetics ; Facial Asymmetry ; Facial Nerve ; Facial Paralysis ; Humans ; Injections, Intramuscular ; Injections, Subcutaneous ; Mouth ; Nasolabial Fold ; Paralysis

Bilateral loss of vestibular sensation from injuries of vestibular hair cells causes individuals suffering poor vision during head movement, postural instability, chronic disequilibrium, and cognitive distraction. A vestibular prosthesis analogous to cochlear implants but designed to modulate vestibular nerve activity during head movement should improve quality of life for these chronically dizzy individuals. An implantable prosthesis that partly restores normal activity on branches of the vestibular nerve should improve quality of life for individuals disabled by this disorder. There have been many efforts to develop and restore 3-dimensional angular vestibule-ocular reflex and the Johns Hopkins vestibular neuro-engineering laboratory has been developing a head-mounted multichannel vestibular prosthesis that restores sufficient semicircular canal function to partially recreate a normal 3-dimensional angular vestibulo-ocular reflex. In this review, their results are described.
Cochlear Implants ; Dizziness ; Ear, Inner ; Hair Cells, Vestibular ; Head Movements ; Prostheses and Implants ; Quality of Life ; Reflex ; Reflex, Vestibulo-Ocular ; Semicircular Canals ; Sensation ; Stress, Psychological ; Vestibular Nerve ; Vision, Ocular

No abstract available.

No abstract available.
Neck Dissection* ; Neck*

No abstract available.

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the incidence and prognostic significance of cervical lymph node metastasis in squamous cell carcinoma (SCC) of the hypopharynx. SUBJECTS AND METHOD: A retrospective review of the 64 patients who were previously untreated for SCC of the hypopharynx and underwent surgery was performed from October 1993 to June 2008. Fifty-six patients had simultaneous bilateral neck dissection, whereas eight had unilateral neck dissection. RESULTS: The median age was 61.0 years (range, 34-75 years) for the study group consisting of 62 males and two females. Evaluating according to the N stages, there were 15 (23.4%), 10 (15.6%), 37 (57.8%), and 2 (3.1%) cases with N0, N1, N2 and N3, respectively. Forty-nine patients (76.6%) had pathologically proven cervical metastasis. Contralateral occult lymph node metastasis occurred in 20.5%. Ipsilateral and contralateral occult metastasis rates for clinically node negative patients were 41.2% and 11.8%, respectively. The most frequent sites for positive neck nodes occuring at each level were as follows: II (48.5%), level III (40.6%), level IV (26.6%), paratracheal node (21.4%), level V (9.4%), levels I (7.8%), and retropharyngeal node (6.3%). The 5-year overall survival and disease-specific survival rates were 50% and 53%, respectively. Cervical nodal metastasis (p=0.044) was statistically significant prognostic factors for disease-specific survival. CONCLUSION: Metastasis to the cervical lymph node group is very frequent and has an impact on survival in patients with hypopharyngeal SCC. Therefore, we advocate bilateral neck dissection in patients with hypopharyngeal SCC with clinically positive metastasis. Ipsilateral elective neck dissection may be needed for clinically node negative patients.
Carcinoma, Squamous Cell ; Female ; Humans ; Hypopharynx ; Incidence ; Lymph Nodes ; Lymphatic Metastasis ; Male ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Retrospective Studies ; Survival Rate

BACKGROUND AND OBJECTIVES: Ultrasonography represents the initial imaging modality of choice for the assessment of the parotid gland tumors. The aim of this study is to evaluate the role of ultrasonography in differential diagnosis of the parotid gland tumors. SUBJECTS AND METHOD: Ultrasonography of the 49 patients with parotid gland tumors were retrospectively reviewed. Histology of all cases was confirmed after parotidectomy. The ultrasonographic features of the most common two histologies, namely, pleomorphic adenoma and Warthin's tumor, were compared. RESULTS: Pleomorphic adenomas were usually solid and they showed lobulation and an exophytic growth. Warthin's tumors usually contained a cystic component, and were usually oval without lobulation and confined to the parenchyma. One of two malignancies showed well-defined margins and five benign tumors showed ill-defined margins. CONCLUSION: The ultrasonographic features should be cautiously used to discriminate among the various histologies of parotid gland tumors.
Adenoma, Pleomorphic ; Diagnosis, Differential ; Humans ; Parotid Gland ; Parotid Neoplasms ; Retrospective Studies ; Salivary Gland Neoplasms ; Salivary Glands

No abstract available.
Hearing Loss* ; Hearing* ; Uveomeningoencephalitic Syndrome*