Combined Approach Technique for theManagement of Large Salivary StonesMany surgeons are using specialized endoscopes to remove

stones from the salivary ducts. Unfortunately, some stones exceedthe dimension of the duct. One approach is to fragment the stoneprior to extraction. An alternative approach is described in whichthe stone is trapped endoscopically and removed through a smallexternal incision. See page 1125

Systemic Review and Meta-analysis of theAdverse Effects of Thyroidectomy Combinedwith Central Neck Dissection as Comparedwith Thyroidectomy AloneIn a meta-analysis which included 1132 patients who underwent

total thyroidectomy with or without central neck dissection (LevelVI). The authors indicate that patients having Level VI neckdissection experience a statistically significant increase in the riskof temporary hypocalcaemia which equated to 1 episode in every7.7 central neck dissections. There was no statistically significantdifference in the rate of recurrent current nerve injury orpermanent hypoparathyroidism. See page 1135

Diabetes Impairs Recovery From Noise-InducedTemporary Hearing LossThe authors report a controlled experiment in which diabetic

animals were subjected to noise. Diabetic animals displayedimpaired amplitude of recovery from the noise-induced injurywhen compared to the normal controls. They speculate thatdiabetic patients are potentially more susceptible to noise-inducedhearing loss, perhaps especially during uncontrolled hyperglyce-mia. See page 1190

Efficacy of Neck Dissection: Are Surgical VolumesImportant?Greater surgical experience may correlate with improved

outcome. The authors report a retrospective analysis of 375 neckdissections performed by surgeons with a variety of experience.The authors demonstrated a ‘‘learning curve’’ for neck dissection.The surgeon with the most experience harvested more nodes perneck than less experienced surgeons. The authors note that no‘‘threshold’’ at which an inexperienced surgeon becomesexperienced was observed. They speculate that surgeons continueto improve with continuing experience. See page 1147

On the CoverThe cover features a diagram of great auricular nerve

sensory distribution divided into 8 regions: Number 1 isthe preauricular region; 2, mandible body; 3, infra-auricular; 4, postauricular; 5, lobule; 6, inferior helix;7, superior helix; and 8, concha. The authors prospec-tively evaluated the sensory function of these regionsafter nerve sacrifice during parotidectomy. Four to fiveyears postoperatively, about one half of patients had noanesthesia and one quarter of patients had neitheranesthesia nor paresthesia. For further reading, pleasesee the article on page 1140 by Ryan and Fee.

Laryngoscope 119: June 2009 In this Issue

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