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Biomedical subjects

B H Britton

Publications and source records attributed to B H Britton.

14 recordsLinked to original sources

Lateral temporal bone resections.

Eighteen consecutive patients underwent a lateral temporal bone resection for the treatment of tumors originating in the auricle, the external auditory canal, the periauricular skin, or the parotid and were retrospectively analyzed. The different lateral temporal bone resections performed have been categorized into four types. The type I resection consists of the removal of the tympanic bone and the external auditory canal lateral to the tympanic membrane. The type II resection consists of the removal of the entire tympanic bone, the tympanic membrane, the incus, and the malleus, preserving the facial nerve and the inner ear. Type III resections remove, in addition to the those structures removed in type II resections, the distal facial nerve and fallopian canal, the mastoid tip, the styloid process, and the stylomastoid foramen. The type IV resection consists of the removal of only the mastoid tip and the inferior portion of the tympanic bone. When the techniques of lateral temporal bone resection are used appropriately, adequate surgical treatment of patients with selected advanced and recurrent malignant tumors of the external ear, the periauricular skin, and the parotid is possible with low morbidity and a high probability of local regional control.

Adult

Schwannoma of the facial nerve in the cerebellopontine angle presenting with hearing loss.

Schwannomas of the facial nerve in the cerebellopontine angle are unusual. The authors describe a 43-year-old woman with progressive hearing loss and dizziness who had a small schwannoma of the facial nerve in the cerebellopontine angle without extension into the internal auditory canal. The tumor was completely removed with preservation of facial nerve function. The diagnosis and management of facial nerve schwannomas are discussed.

Adult

Bruit caused by aberrant carotid artery in the middle ear.

An aberrant course taken by the internal carotid artery during its development may lead it through, rather than anterior to, the middle ear space. The resulting symptoms and signs, including a pulsatile bruit in and around the ear and the presence of a mass behind the tympanic membrane, require differentiation from those of glomus jugulare tumor.

Carotid Artery, Internal

Cooperative neuro-otologic management of acoustic neuromas and other cerebellopontine angle tumors.

Over a recent 16-month period, 35 cerebellopontine angle tumors were removed at our institution by a surgical team consisting of one neurosurgeon and one otologist. Nineteen tumors were less than 2 cm in diameter and six were greater than 4 cm. There were 26 acoustic neuromas, six meningiomas, two epidermoid tumors, and a glossopharyngeal schwannoma. A suboccipital transmeatal approach was used in the majority of patients. There were no deaths. Thirty-two patients had an excellent outcome. Twenty-four patients had complete tumor removal (92% of the acoustic neuromas). The facial nerve was preserved anatomically in all but one patient, who had nerve grafting intraoperatively and has partial recovery of function. Thirteen of the 24 patients who had auditory function retained some of it postoperatively. With current diagnostic techniques, combined with the neurosurgical and otologic team approach, the majority of patients with acoustic tumors of all sizes may expect a complete resection of the tumor with a good outcome. Certainly, early diagnosis and resection of smaller tumors will increase the likelihood that hearing will be preserved, thus providing impetus for aggressive diagnostic and surgical treatment of patients with these lesions.

Adolescent

Vertigo in the pediatric and adolescent age group.

Since episodic vertigo in the pediatric and adolescent age group is unusual and therefore not well known to most otolaryngologists, we present six cases to show some of the various presentations and different underlying causes. These cases covered a wide diagnostic spectrum: meningioma, medulloblastoma, childhood migraine with vestibular symptoms, childhood Meniere's syndrome (one case due to perilymph fistula), and benign paroxysmal vertigo of childhood. The two patients with tumor and the patient with perilymph fistula were treated surgically; the other patients are being managed conservatively since these childhood conditions usually tend to diminish with time.

Adolescent

Vestibular responses to pressure variations: a review.

A selected review of the literature concerning different forms of pressure stimulation of the normal and abnormal vestibular labyrinth is presented. On the basis of this review, it can be stated that there are definite vestibular signs and symptoms associated with pressure stimulation. The exact mechanisms remain in doubt. The responses, however, appear to be mediated through the vestibular hair cells.

Air Pressure

Lipomas of the internal auditory canal.

We present two cases of lipoma of the cerebellopontine angle (CPA), which brings, to our knowledge, the total reported in the literature to six. These cases had a clinical, surgical, and postoperative course that was similar to a small acoustic neuroma. The roentgenographic aspects were in keeping with small, CPA tumors. A review of the literature of CPA tumors and lipomas of the CNS is presented. We discuss the controversy surrounding the origin of lipomas of the CNS.

Adult

Carcinoma of the external auditory canal.

Successful management of carcinoma of the external auditory canal depends upon four factors: 1. early diagnosis is imperative if a high cure rate is to be expected; 2. correct evaluation of the extent of the malignancy; 3. adequate surgery based upon correct evaluation; and 4. postoperative radiation in certain selected cases. In this review of 35 cases, two factors were used to determine whether the disease was localized or extensive. When extension occurs inot the mastoid as deep as the middle ear cleft or into the facial nerve, it should be designated as extensive tumor. Tumors which do no go as deep as the facial nerve or involve the mucosa of the middle ear should be designated as localized tumors. In localized tumors, it is possible to perform a wide en bloc resection of the bony and cartilaginous external auditory canal including the tympanic membrane and malleus, and if necessary, including the superficial lobe of the parotid. Postoperative radiation is indicated when the pathological specimen shows unclear margins in the surgical dissection. With localized tumors, en bloc resection of the external auditory canal offers a high cure rate. In extensive lesions, an en bloc dissection removing the bulk of the tumor mass, followed by irradiation, seems to offer at least as good a prognosis as more radical surgery.

Adenocarcinoma

Microscopic characteristics of the acoustic tumor in relationship of its nerve of origin.

The microscopic characteristics of a 0.9 cm vestibular schwannoma en bloc resected with its nerve of origin which occurred in a 54-year-old white woman presenting with a two-year history of a unilateral progressive sensori-neural hearing loss is described. The tumor originated in the inferior vestibular portion of the vestibular division of the VIIIth cranial nerve just medial to the internal auditory canal meatus at approximately the level of the glial-non-glial junction. The tumor demonstrated two distinctly different, yet simultaneous, modes of involvement with its nerve of origin: 1. inseparable cellular continuity; and 2. peripheral compression of the remainder of the nerve within the tumor capsule. Despite only slight microscopic continuity of the nerve histologically, electronystagmography showed no unilateral weakness on bithermal caloric testing, and pure tone and speech audiometry was only moderately depressed.

Audiometry