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Exactly twenty years ago, David Cogan of Harvard University, Department of Ophthalmology, reported four cases of "Nonsyphilitic Interstitial Keratitis Associated with Vestibulo-auditory Symptoms." All four cases came to him within a year, all from the environs of Boston. In his cases the corneal changes progressed rela tively little but the vestibular condition incapacitated the patients for several weeks or months and the auditory state led to profound deafness.Cogan discussed the differences between this disease and syphilitic keratitis, noting that in the latter condition, only 4% of the cases developed deafness and the deafness did not occur until months or years after the keratitis. Dr. Cogan and his associates have continued to report on these cases of non-syphilitic keratitis with vestibular and cochlear symptoms, as in 1949 when the case load had risen to 13, 1959 when two deaths but no autopsies were reported and 1963 when a limited autopsy on a 14 year-old boy was obtained.Reports of approximately 36 of these cases have come to our attention. They mostly concern relatively young people, although the age range is now ΐΥζ years to 60. Only one Negro and one Cuban are in the list. Reports have been in the Italian and Swiss literature. The disease was not listed on the program of a recent symposium in Philadelphia on vestibular diseases, October, 1964.

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In perforator flaps, anastomosis between flap and recipient vessels in the neck area is often difficult due to small vessel diameter and short pedicle. The aim of this study was to investigate whether the retrograde flow of the distal, paramandibular part of the facial artery would provide sufficient pressure and size to perfuse perforator flaps. Before and after occlusion of the contralateral facial artery, retrograde and anterograde arterial pressure was measured on both sides of the facial artery in 50 patients. The values were compared with the mean systemic arterial pressure. Diameters of facial arteries in the paramandibular region and perforator flap vessels were evaluated by morphometry. Arterial pressure in the distal facial artery with retrograde flow was 76% of the systemic arterial pressure. The latter equaled approximately the anterograde arterial pressure in the proximal end of the facial artery. Mean arterial pressure of the facial arteries decreased after proximal occlusion of the contralateral facial artery, which was not significant (P = 0.09). Mean diameter of the distal facial arteries in the mandibular region was 1.6 mm (range 1.3-2.2 mm; standard deviation 0.3 mm; n = 50), that of the perforator flap arteries 1.3 mm (0.9-2.6 mm; 0.4 mm; n = 20). Facial arteries, based on reverse flow, successfully supported all 20 perforator flaps. Retrograde pulsatile flow in the distal facial artery sustains perforator flaps even if the contralateral facial artery is occluded. Proximity of the distal facial arteries to the defect compensates for short pedicles. Matching diameters of the arteries are ideal for end-to-end anastomosis.