No abstract

Three hundred sixty-four patients referred to the Chicago Otology Group for acoustic tumor removal between 1981 and 1995 were reviewed in a retrospective fashion. Of this group, 60 patients were candidates for hearing preservation surgery and thus underwent one of two surgical approaches to remove the tumor and preserve hearing. Eighteen patients had tumor removal via the middle cranial fossa approach, and 42 patients had tumor removed via the retrosigmoid approach. Of the 42 patients who underwent retrosigmoid removal, 33% had hearing preserved overall. Of the 18 patients in the middle fossa group, 44% had hearing preserved overall. The average tumor size of patients with preserved hearing in the retrosigmoid group was 1.4 cm, and in the middle fossa group was 0.74 cm. Of significance was the fact that in both groups of patients with a tumor of 1.5 cm or less there was a 50% chance of hearing preservation. In the group of patients with tumors larger than 1.5 cm there was only a 16% chance of preserving hearing. We propose that these data can be used for better counseling of patients preoperatively as to the chances of hearing preservation and the type of approach appropriate for each case.

Increased areas of anesthesia in the oral cavity have been shown to significantly impair oral function in normal individuals. In patients who undergo oral cavity reconstruction, loss of sensation plays a major role in producing disturbances in postoperative oral function. Free tissue transfer techniques have permitted the problem of sensory loss to be addressed through the use of sensate cutaneous free flaps, in which microneural anastomoses are performed between a sensory nerve supplying the flap and a recipient nerve in the head and neck. To critically assess the results of such reconstructions, the effect of sensory restoration on oral cavity rehabilitation must be studied. As a first step toward this goal, normal values for sensory discrimination of the floor of mouth and tongue are needed. Previous studies of oral sensation failed to examine the ventral tongue and floor of mouth. The purpose of this study is to determine the surface sensibility of these regions in healthy patients and in patients who received radiation therapy to the oral cavity. Sensation was evaluated using static and moving two-point discrimination in 90 healthy subjects divided equally into three age groups: 20 to 40 years, 41 to 60 years, and 61 to 80 years. In addition, 20 patients who received radiation therapy were studied. The mucosa of the dorsal and ventral aspects of the lateral tongue, tongue tip, and floor of mouth was examined. The tongue tip is the most sensitive area, followed by the dorsal lateral tongue, ventral lateral tongue, and floor of mouth. The effects of age and radiation therapy on sensory discrimination are discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Of 432 patients referred for treatment of their cerebellopontine angle tumors, 53 with acoustic neuromas were managed initially without intervention but with adequate follow-up. Mean presenting tumor size in this subgroup of patients was 0.98 cm (range, 0.2 to 3.0 cm), and average growth rate was 0.16 cm per year. Twenty-one patients demonstrated tumor growth with a mean follow-up interval of 1.9 years. Of these 21 patients, 14 underwent microsurgical excision, 4 received radiation, 2 continued to be observed and 1 was lost to follow-up. The remaining 32 (60%) had no demonstrable growth with a mean follow-up of 2.13 years. Of these patients, 29 continue to be followed and 3 were lost to follow-up. Of the information evaluated, the only statistically significant relationship is with larger tumor size in elderly patients--most likely reflecting the propensity to opt for conservative treatment in elderly patients. Tumor growth rate was unrelated to presenting tumor size or patient age, which suggests that conservative treatment may be appropriate in selected patients.