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PURPOSE: To determine whether the use of fibrin glue has an impact on wound drainage created in an animal model. MATERIALS AND METHODS: Fibrin glue was prepared from single-donation autologous phlebotomy before surgery. Bilateral skin flaps were raised over the parotid gland in 10 rabbits. After exposure of the parotid, fibrin glue was applied on one side using an atomizer. The opposite side was treated with normal saline. Self-suction drains were placed under each flap and the wounds closed. Drainage was recorded daily for 7 days. RESULTS: Drainage differed significantly (P = .001) between the two sides on the first postoperative day and subsequent days. The average drainage on the fibrin-glue-treated side was 2.1 mL on the first day and 0.5 mL on subsequent days. On the nontreated side, the average output was 13.4 mL on the first day and 4.6 mL on subsequent days. CONCLUSIONS: This preliminary animal investigation showed that fibrin glue treatment decreased wound drainage. It is hoped that this concept may be applied to commonly performed head and neck procedures in which large flaps are elevated and large potential spaces are created. By decreasing the amount of drainage, fibrin glue has the potential to improve coaptation of flaps and minimize potential for seroma and hematoma formation. In some cases, the use of closed suction drains may be shortened and possibly eliminated, with shorter length of hospitalization.

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Adenomatous lesions of the temporal bone represent a diverse group of neoplasms. At least three histopathologic patterns have been described: glandular; ribbon-like, or "festooning;" and aggressive papillary. Combinations of glandular and ribbon-like histologies in the same lesion are not uncommon. The glandular and ribbon-like histologies have been associated with carcinoid tumors, and the aggressive papillary tumor has been considered a separate entity. Recently, the endolymphatic sac has been proposed as the site of origin of the aggressive papillary lesions. Previous reports have described neuroendocrine properties with characteristics embracing the three histologic types. The authors postulate that the neural crest is the site of origin of this unusual group of neoplasms. Immunohistochemical analysis on the pathologic specimens of patients with adenomatous lesions of the temporal bone was performed to test this hypothesis. From 1975 to 1992 seven patients were treated at the Cleveland Clinic Foundation with a diagnosis of middle ear adenoma. A panel of special stains for neuroectodermal markers, including synaptophysin, chromogranin, neuron specific enolase, calcitonin, and serotonin was used on the paraffin-embedded formalin-fixed specimens. Three lesions were also evaluated by electron microscopy, all demonstrating dense core, intracytoplasmic granules. Three ribbon-like tumors were positive for synaptophysin and chromogranin, and two of these were positive for serotonin. One glandular tumor was positive for synaptophysin, and an aggressive papillary tumor was positive for synaptophysin and neuron specific enolase. An additional papillary tumor was referred following a third recurrence without accompanying immunohistochemical data. Cholesteatoma-like material was identified with a few glandular cells interspersed, all negative by immunohistochemical evaluation. The seventh specimen, initially diagnosed as papillary adenoma on light microscopy, was not studied by the aforementioned stains, and was later identified as a papilloma of sinonasal origin. The neural crest gives rise to pluripotential stem cells with widespread anatomic distribution, including the temporal bone. Because immunomarkers used in this study are specific for neuroectodermal differentiation, results suggest that temporal bone adenomas have neuroendocrine characteristics and could be derived from the specialized neuroectoderm of the neural crest.

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We reviewed the records of 27 patients who underwent primary mandibular reconstruction with AO plates to investigate the outcome and complications of this procedure. Immediate soft-tissue flap coverage was required in 26 patients. Early complications were seen in 44% of the patients, with the highest incidence after irradiation (P = 0.02). Late complications were mostly related to tumor recurrence (12). Late complications not associated with recurrence were persistent pain (2), minor infections (3), plate exposure (3), and plate fracture (1). Good to excellent cosmetic results were obtained in all but 1 patient. Full mastication was not possible for any of our patients, and therefore function was not fully restored. Speech and deglutition were mostly influenced by the amount of soft-tissue resection. Mean follow-up was 20 months (range 3 to 52). At last evaluation, 12 patients were alive and free of disease, and 15 were dead of disease or other causes. Our results show that primary mandibular reconstruction with rigid plates is a safe, effective, and reliable technique to restore mandibular continuity and cosmesis. For lateral defects, this method is a viable alternative to free vascularized osseocutaneous flaps.

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Stroke often impairs the ability of the vocal cords to close during deglutition, resulting in aspiration. The current study is a further advance on the application of the concept of an artificial reflex arc during swallowing. The second and third cervical branches were bilaterally isolated in four dogs and baseline sensory nerve traffic was detected via tripolar perineural electrodes. Cervical skin pressure-induced suprathreshold signals were used to trigger vocal cord contraction via bipolar electrodes passed around the recurrent laryngeal nerves. Skin subtended by the cervical nerves was implanted over the lateral aspect of the pyriform sinuses for 1 week. After reexploration, glottic closure was verified on videotape as surges in sensory nerve traffic were induced by mechanical stimulation of the pharynx. The possibility of artifactual stimulation was ruled out by lack of electrode motion during pharyngeal stimulation, spontaneous firing in the sensory nerve during light anesthesia, and sensory frequency differing from ambient 60-Hz noise. This article introduces the concept of autogenous functional graft as a basis for afferent information in electronic systems for dynamic rehabilitation of swallowing disorders.

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Surgical control of severe epistaxis is usually reserved for cases refractory to more conservative techniques. We present our experience with intraoral ligation of the maxillary artery as it courses through the buccal fat pad before it enters the pterygopalatine fossa and branches posterior to the maxilla. This technique has been found useful in the control of nasal hemorrhage as well as an adjunct to other surgical procedures, such as removal of benign and malignant neoplasms involving the maxilla and paranasal sinuses. This technique was used for ligation of the maxillary artery in 20 patients. The artery was readily identified in some cases, but required more extensive dissection in others; therefore, an anatomic study in 18 preserved and fresh cadaver specimens was undertaken to investigate the variability of the maxillary artery in the region of the buccal fat pad. There appeared to be significant variation in the distance from the buccal mucosal incision site, as well as variation in the relationship to the pterygoid muscles. This relationship to the pterygoids explains the occasional difficulty in locating the artery for ligation. This technique represents a reasonable alternative to the more traditional transantral approach to ligation of the maxillary artery, as long as the surgeon understands the anatomy of the region, its variations, and where the artery may be located if not immediately apparent. No major complications have been experienced.

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In conclusion, the rat primary motor cortex appears to be organized into irregularly shaped patches of cortex devoted to particular movements. The location of major subdivisions such as the forelimb or hindlimb areas is somatotopic and is consistent from animal to animal, but the internal organization of the pattern of movements represented within major subdivisions varies significantly between animals. The motor cortex includes both agranular primary motor cortex (AgL) and, in addition, a significant amount of the bordering granular somatic sensory cortex (Gr(SI)), as well as the rostral portion of the taste sensory insular or claustrocortex (Cl). The rat frontal cortex also contains a second, rostral motor representation of the forelimb, trunk and hindlimb, which is somatotopically organized and may be the rat's supplementary motor area. Both of these motor representations give rise to direct corticospinal projections, some of which may make monosynaptic connections with cervical enlargement motoneurons. Medial to the primary motor cortex, in cytoarchitectonic field AgM, is what appears to be part of the rat's frontal eye fields, a region which also includes the vibrissae motor representation. The somatic motor cortical output organization pattern in the rat is remarkably similar to that seen in the primate, whose primary, supplementary and frontal eye field cortical motor regions have been extensively studied.

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Fetal cerebral cortical tissue was transplanted into the cerebral hemisphere of 0-1-day-old rats. In some cases, the transplants were placed into or adjacent to cortical lesion cavities made immediately prior to transplantation. Injections at maturity of fast blue and diamidino yellow into the host contralateral cortex and ipsilateral thalamus demonstrated the presence of callosal and thalamic projections from transplant to host. Numerous single-labeled neurons were often arranged in cell bands or clusters. This apparent topography and the absence of double-labeling resembled normal labeling patterns.

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Although several neuroanatomical studies have previously described various subdivisions of the rat thalamus, no comprehensive description of the entire thalamus accompanied by photomicrographs has been available. To provide such a description, the cytoarchitecture of the normal rat thalamus was studied in the coronal plane using a series of celloidin embedded, Nissl-stained 33 micrometers sections spaced 400 micrometers apart. Using the criteria of cell packing density, relative cell size, and the presence or absence of fibers, the thalamus can be subdivided into a ventral nuclear complex which includes the ventrolateral, ventromedial, and ventrobasal nuclei; the intralaminar nuclei which include central medial, central lateral, paracentral and parafascicular nuclei; the midline nuclei which include the medioventral, paratenial, rhomboid, paraventricular, and submedial nuclei; the anterior nuclear group which include the anterodorsal, anteroventral, and anteromedial nuclei; the mediodorsal nucleus; the lateral nuclear complex including both lateral posterior and lateral dorsal; the posterior nuclear complex; the reticular nucleus; and the diencephalic-mesencephalic junction. The terminology used is based on previous studies.

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