Surgery

Abstract

We conducted a study to evaluate functional and cosmetic outcomes following reconstruction of the mandibular condyle with direct placement of a vascularized free fibula. We retrospectively reviewed the cases of all patients who had undergone hemimandibulectomy and condyle resection with immediate reconstruction at the Mayo Clinic in Rochester, Minn., between Nov. 1, 2005, and Jan. 31, 2007. We found 7 such cases, all of which occurred in men aged 32 to 61 years (mean: 50.7). Six of these patients had a malignancy and 1 had osteomyelitis. Postoperatively, 6 patients had no difficulty with occlusion, which was rated as “good” or “excellent” at their 6-month follow-up visit; the other patient had an open-bite deformity, but he was able to masticate solid food and maintain an oral diet. Cosmesis was generally satisfactory, and all patients maintained intelligible speech. We conclude that free fibula transfer with direct seating of the fibula into the condylar fossa followed by aggressive physiotherapy provides acceptable functional reconstruction of the mandibulectomy-condylectomy defect.

Abstract

A 3-year, single-center, prospective study was undertaken to measure the effect and long-term results of using the Monarch Nasal Implant to surgically correct nasal valve dysfunction. Thirty-nine patients were implanted, with follow-up lasting 36 months for 9 of the patients. Implant effectiveness and maintenance of effectiveness were determined through acoustic rhinomanometry and a subjective patient questionnaire. Rhinomanometry studies and patient questionnaires revealed a significant initial improvement in internal nasal valve areas and patient symptoms; the improvements were maintained or had even increased at 36 months. The cosmetic changes were acceptable to the patients. The Monarch Nasal Implant provides a consistent and lasting correction of nasal valve dysfunction with minimal drawbacks when properly used.

Abstract

We conducted a retrospective study of the long-term functional results of surgery for head and neck paragangliomas. Our study population was made up of 9 patients—4 men and 5 women, aged 22 to 59 years (mean: 46.6; median: 51)—who had undergone surgical excision of a head and neck paraganglioma from January 2002 through December 2006 in the ENT Department at Pugliese-Ciaccio Hospital in Catanzaro, Italy. Of the 9 paragangliomas, 4 were carotid body tumors, 2 were glomus tympanicum tumors, and 3 were glomus vagale tumors. None of the cases was bilateral or hereditary. Complete tumor resection was achieved in 8 patients; in the remaining patient, a small amount of intradural residual vagus nerve paraganglioma had to be left in situ. The internal carotid artery was preserved in all 4 resections of carotid body tumors. There was only 1 case of postoperative lower cranial nerve deficits, which occurred in a patient with a carotid body tumor. Follow-up ranged from 12 to 53 months (mean: 37.2; median: 36), and no recurrences were documented. Our small sample showed that surgical treatment of head and neck paragangliomas provided excellent tumor control with low postoperative morbidity, even in patients with large tumors. A wait-and-scan policy may be more appropriate for patients at an advanced age or who are otherwise at high surgical risk, as well as for those whose tumors have recurred following radiotherapy.

Abstract

We conducted a 3-year retrospective study to examine the results of preoperative 
hematologic screening, the incidence of postoperative bleeding, and the possible 
relationship between the two factors in patients who had undergone tonsillectomy 
with or without adenoidectomy. Our study population was made up of 875 patients—441 
boys and 434 girls, aged 2 to 18 years (mean: 7.52 ± 4.25)—who had been treated at 
our institution from January 2004 through December 2006. In addition to demographic 
data, we compiled information on each patient’s medical and surgical history, personal 
and family history of abnormal bleeding, indication for tonsillectomy, and preoperative 
hematologic screening results. The latter included determinations of the prothrombin 
time, activated partial thromboplastin time, international normalized ratio (INR), and 
platelet count. A total of 748 patients (85.5%) had normal findings on preoperative 
hematologic screening, and 127 (14.5%) had at least one abnormality. Postoperatively, 
hemorrhagic complications occurred in 31 children (3.5%)—in 22 of the 748 patients 
with normal screening results (2.9%) and in 9 of the 127 with a screening abnormality 
(7.1%); the difference between the two groups was statistically significant (p = 0.041). 
The abnormalities in the latter group consisted of an elevated INR but no otherwise 
identifiable coagulopathy. Another 14 patients with an abnormal screening result 
(11.0%) were found to have at least one coagulopathy that was newly diagnosed during 
our preoperative evaluation; they were treated perioperatively, and none bled 
postoperatively. Of 21 patients who had a personal or family history of abnormal 
bleeding, 5 (23.8%) were found to have a coagulopathy, but none bled following surgery. 
In conclusion, we found that preoperative hematologic screening identified patients 
with undiagnosed coagulopathies, and with appropriate treatment our surgeons were able 
to prevent some bleeding events in these patients. Our finding that patients with a 
mildly elevated INR had a higher incidence of postoperative hemorrhage warrants 
further study.

Abstract

We conducted a study to validate the expression of PLUNC (palate, lung, and nasal epithelial clone) protein in nasal polyp and chronic sinusitis tissue by immunohistochemistry. We also explored the relationship between the intensity of positive immunohistochemical staining for PLUNC protein and postoperative therapeutic efficacy. Our study population consisted of 34 patients with nasal polyps and 30 with chronic sinusitis who had undergone surgical treatment, along with 18 healthy controls who did not undergo surgery. All samples were stained according to the streptavidin-peroxidase immunohistochemical method to examine PLUNC protein expression. The surgical patients were evaluated for clinical therapeutic efficacy 6 months postoperatively. The association between efficacy and the intensity of PLUNC protein positivity was examined by the Spearman rank correlation analysis. Intensity was rated as either +++(>50% positive cells), ++ (26 to 50% positive cells),+ (≤25% positive cells), or–(no positive cells). We found that the most common levels of PLUNC positivity were + in the patients with nasal polyps, +++ in the patients with chronic sinusitis, and ++ in the controls (p< 0.01). Analysis of the Spearman rank correlation indicated that the intensity of PLUNC protein expression was significantly correlated with postoperative therapeutic efficacy (p< 0.001). We conclude that PLUNC protein is an essential factor in the innate defense mechanism of the nasal mucosa. The immunohistochemical staining of PLUNC protein could have clinical benefit in terms of predicting therapeutic efficacy and outcomes in patients with nasal polyps or chronic sinusitis.