Other ENT Topics

Survival characteristics of injected human cartilage slurry in a nude mouse model: A preliminary study

July 13, 2014     Bounmany Kyle Keojampa, MD; Jacob Pieter Noordzij, MD; Bohdana Burke, MD; Joseph Alroy, DVM; Vartan Mardirossian, MD; Alphi Elackttu, MD; Zhi Wang, MD
article

Abstract

We conducted a study to examine the viability, host response, and volume retention characteristics of drilled human septal cartilage slurry when injected into an athymic nude mouse model. We injected 0.2 ml of the slurry into the hind limbs of 6 mice. The mice were sequentially sacrificed over a period of 180 days. Histologic reviews of the hind limbs were performed to determine the viability of injected chondrocytes, host response, and volume retention. Specimens were obtained and histomorphologic analysis was performed at 1, 30, 90, and 180 days after injection. We identified viable cartilage throughout the study. Cartilage injection was well tolerated, and minimal inflammatory reaction occurred without significant adverse effects. The injected bolus of cartilage was found to have progressively dispersed throughout the muscle over time. Our findings warrant further investigation with a larger cohort of nude mice or possibly human subjects.

Pediatric rhabdomyosarcoma

July 13, 2014     Rosemary Ojo, MD; Si Chen, MD; Liset Pelaez, MD; Ramzi Younis, MD
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All children with rhabdomyosarcoma require multimodality therapy to maximize local tumor control. This can involve different combinations of chemotherapy, surgery, and radiation therapy.

Reinnervation of facial muscles with only a cross-facial nerve graft in a 25-year-old patient with congenital facial palsy

July 13, 2014     Kamal Seyed-Forootan, MD; Hamid Karimi, MD; Esmaiil Hasani, MD
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Abstract

The standard method for managing chronic facial palsy is the two-stage free-muscle flap. We report a case involving a 25-year-old patient who had facial palsy from her birth. Twelve months after the first stage of a cross-facial nerve graft, we found that the voluntary movements of her facial muscles had returned. Within the following 12 months, she gained complete recovery of her movements on the affected side, as confirmed by electromyography studies. This case demonstrates that neurotization of facial muscles in chronic facial palsy is possible. However, further studies are needed to define the trophic effects or trophic mediators that can restore function to atrophied facial muscles and to determine which patients might benefit from the cross-facial nerve graft procedure without the free-muscle graft procedure.

Evidence-based update on tympanostomy tube placement for otitis media in children

July 13, 2014     Jeffrey Cheng, MD; Lisa Elden, MD
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Controversy has grown over the indications, timing, and efficacy of tympanostomy tube placement compared with watchful waiting.

Mitek bone-anchored static suture suspension of the oral commissure

June 8, 2014     Candace Hrelec, MD; Stephen Smith Jr., MD
article

Static facial suspension plays an important role in long-standing facial nerve paralysis, and techniques continue to evolve. Although other procedures are less morbid and invasive than our dynamic facial technique, they also have their complications and limitations.

Harmonic Scalpel versus electrocautery and surgical clips in head and neck free-flap harvesting

June 8, 2014     Nichole R. Dean, DO; Eben L. Rosenthal, MD; Bruce A. Morgan, MD; J. Scott Magnuson, MD; William R. Carroll, MD
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Abstract

We sought to determine the safety and utility of Harmonic Scalpel-assisted free-flap harvesting as an alternative to a combined electrocautery and surgical clip technique. The medical records of 103 patients undergoing radial forearm free-flap reconstruction (105 free flaps) for head and neck surgical defects between 2006 and 2008 were reviewed. The use of bipolar electrocautery and surgical clips for division of small perforating vessels (n = 53) was compared to ultrasonic energy (Harmonic Scalpel; Ethicon Endo-Surgery, Inc., Cincinnati, Ohio) (n = 52) free tissue harvesting techniques. Flap-harvesting time was reduced with the use of the Harmonic Scalpel when compared with electrocautery and surgical clip harvest (31.4 vs. 36.9 minutes, respectively; p = 0.06). Two patients who underwent flap harvest with electrocautery and surgical clips developed postoperative donor site hematomas, whereas no donor site complications were noted in the Harmonic Scalpel group. Recipient site complication rates for infection, fistula, and hematoma were similar for both harvesting techniques (p = 0.77). Two flap failures occurred in the clip-assisted radial forearm free-flap harvest group, and none in the Harmonic Scalpel group. Median length of hospitalization was significantly reduced for patients who underwent free-flap harvest with the Harmonic Scalpel when compared with the other technique (7 vs. 8 days; p = 0.01). The Harmonic Scalpel is safe, and its use is feasible for radial forearm free-flap harvest.

Postauricular fascia in augmentation rhinoplasty

June 8, 2014     Aldo Benjamin Guerra, MD, FACS
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Abstract

Ten rhinoplasty operations performed using postauricular fascia for the purpose of augmenting the radix and dorsum of the nose were analyzed retrospectively. All the operations were performed over a 1-year period, between 2005 and 2006. The fascia of the postauricular area has been used as a source of pliable soft-tissue grafts in primary and revision rhinoplasty. It may be easily accessed using a single sulcus incision that also enables harvesting of ear cartilage grafts. Deficiency in the radix is an overlooked abnormality seen in many patients undergoing primary as well as revision rhinoplasty after aggressive hump removal. Recent trends in rhinoplasty have been to avoid the overly reduced nasal skeleton and to create a more balanced nasal surgery result. This article presents the use of the postauricular fascia as a radix graft that has been found to be simple to carry out, reliable, and long lasting. In addition, the fascia graft is useful in the camouflage of various nasal deformities in the dorsum and sidewalls. The average patient follow-up for the study was 24 months.

Pediatric sensorineural hearing loss

June 8, 2014     Dennis J. Kitsko, DO, FACS, FAOCO
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Children with hearing loss should avoid noise exposure, and families should be counseled to protect their child's hearing environment and to educate their children about the long-term need to avoid excessive noise exposure.

How do pediatric adenoidectomy and adenotonsillotomy influence maternal psychological status?

June 8, 2014     Olaf Zagolski, MD, PhD and Jan Kulisiewicz, MD, PhD
article

Abstract

We conducted a study to determine the impact that pediatric adenoidectomy or adenotonsillotomy (adenoidectomy with a partial tonsillectomy) had on the short-term psychological status of the children's mothers. Mothers of 100 treated children were examined with the 14-item Hospital Anxiety and Depression Scale (HADS) questionnaire immediately before the operation and 3 days afterward; to establish a baseline for control purposes, they completed another questionnaire 10 days postoperatively. We also compiled data for the mothers' demographic information and the children's physical status. In the preoperative period, we found that (1) the anxiety scores of half the mothers were abnormal, (2) depression scores were higher in the adenotonsillotomy group, and (3) anxiety and depression scores were lower in the mothers with more education and in the mothers who had a personal or family history of previous surgery. At 3 days postoperatively, anxiety and depression scores were again lower in the more educated mothers, and lower in the absence of postoperative fever. We conclude that mothers whose children are undergoing adenoidectomy or adenotonsillotomy, particularly the latter, and those with less education may require some psychological intervention. Such help may also be needed when postoperative complications occur.

Evaluating the role of single-photon emission computed tomography in the assessment of neurotologic complaints

May 7, 2014     Shruti S. Joglekar, MD; Jason R. Bell, MD; Malka Caroline, MD; Paul J. Chase, DO, FAOCR; James Domesek, MD; Pinal S. Patel, ARRT, CNMT; Robert T. Sataloff, MD, DMA, FACS
article

Abstract

We conducted a retrospective study to reexamine the value of single-photon emission computed tomography (SPECT) in the evaluation of patients with neurotologic complaints, and to assess the intra- and inter-radiologist variability of SPECT readings. Our study population was made up of 63 patients-23 men and 40 women, aged 34 to 91 years (mean: 59)-who had presented to a tertiary care otolaryngology practice and university hospital for evaluation of head trauma, sensorineural hearing loss, tinnitus, and/or vertigo. All patients had undergone brain scanning with SPECT during their evaluation, and almost all had also undergone magnetic resonance imaging (MRI) and standard computed tomography (CT). We compared the findings of all three imaging modalities in terms of their ability to detect neurotologic abnormalities. We found that detection rates were very similar among the three modalities; abnormalities were found in 24% of SPECT scans, 26% of MRIs, and 23% of CTs. Nevertheless, we did find that among 60 patients who underwent all three types of imaging, 13 (22%) exhibited areas of cerebral hypoperfusion on SPECT while their MRIs and CTs were read as either normal or nonspecific. In all, 18 of these 60 patients (30%) exhibited normal or nonspecific findings on all three types of imaging. In addition, when SPECT scans were read by the same radiologist at different times, different results were reported for 17 of the 63 scans (27%). Likewise, when SPECT scans were read by different radiologists, different results were reported for 21 of 63 scans (33%). We conclude that SPECT may be a valuable complementary diagnostic modality for making a comprehensive neurotologic evaluation and that it may detect abnormalities in some patients whose other imaging is read as normal. However, we did not find that SPECT was the most sensitive of the three modalities in neurotologic evaluation, as we had previously found in a preliminary study that the senior author (R.T.S.) published in 1996. In addition, with respect to our radiologists, both their intra- and inter-reader reliability was low, and we recommend additional study on this matter.

A "nail-biting" case of an airway foreign body

May 7, 2014     Parker A. Velargo, MD; Jennifer D. McLevy, MD
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While cases of large, completely obstructing foreign bodies in the subglottis would lead to sudden respiratory distress, the initial presentation of smaller foreign bodies in the subglottis can be quite similar to croup, presenting with biphasic stridor, cough, and/or the steeple sign.

The cosmetic Z-plasty: Restoring and refining an old technique for neck rejuvenation

May 7, 2014     Nicholas Vendemia, MD; David E. Rosow, MD; Anthony N. LaBruna, MD
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Abstract

Direct excision of the “turkey neck” skin fold with Z-plasty closure was introduced in the 1970s, but it has fallen out of favor in an era in which much emphasis is placed on minimizing visible scars. Although the newer techniques may effectively improve the aesthetic contour of the neck without leaving visible scars, they may not be optimal for selected patients who want a quick, “no-hassle” correction of their neck contour without changing the overall appearance of their face. We conducted a retrospective study of 50 patients-47 men and 3 women, aged 59 to 80 years (mean: 70)-who had undergone cosmetic Z-plasty performed by the senior author (A.N.L.) over a 9-year period. These patients either did not want or were not candidates for a face-lift or other procedure. Patients' charts were examined for demographic data, complications, and overall satisfaction with the procedure. In 46 of the 50 cases, the initial cosmetic result was acceptable to both the patient and the surgeon. The only complications were recurrent or residual areas of skin redundancy or dissatisfaction with the scar, but these were easily corrected with a second procedure using local anesthesia in the office setting. We conclude that cosmetic Z-plasty is a safe and effective means of correcting turkey neck deformity in patients who desire a procedure with a short operating time, a brief recovery period, a low complication rate, and a minimal effect on the overall appearance of their face. Although cosmetic Z-plasty is frequently considered to be antiquated, we believe refined versions of this procedure can still be of value to the plastic surgeon. In addition to describing our study results, we also describe in detail our surgical technique, including several contemporary refinements.

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