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The immediate use of a silicone sheet wound closure device in scar reduction and prevention

February 24, 2016  |  James R. Parry, DO; Howard D. Stupak, MD; Calvin M. Johnson, MD

Abstract

Silicone has been used successfully postoperatively in the prevention of hypertrophic and other types of adverse scars. The Silicone Suture Plate (SSP) is a new, minimally invasive, sterile wound closure device that is applied intraoperatively to prevent adverse scarring. The SSP device permits immediate application of silicone while concurrently allowing for wound-edge tension redistribution. In this prospective, controlled, single-blinded clinical study, 8 consecutive patients undergoing deep-plane rhytidectomy were selected. SSP devices were placed on the patients' posterior rhytidectomy hairline incision; the mirror-image control site underwent standard suturing techniques. Three blinded, independent raters assessed the treatment and control sides at 6-week and 4-month follow-up visits, using the Objective Scar Assessment Scale (OSAS), a validated scar assessment tool. The 6-week OSAS scores revealed an 18.4% improvement on the side with the SSP device (13.3) when compared to the control side (16.3). The 4-month OSAS scores showed a 27.3% improvement on the treatment side from 12.7 (control) to 9.2 (SSP). These OSAS results were found to be statistically significant when taken as an aggregate of the observers' scores, but not when observers' scores were measured individually (p < 0.05). In our series of patients, we showed promising results with the use of the SSP device. Early silicone application and tissue tension distribution contributed to an overall more aesthetically pleasing scar compared to those seen with standard suturing techniques, although more testing is required.

Endoscopic view of a unilateral nasal soft-tissue obstruction

February 24, 2016  |  Joseph P. Mirante, MD, MBA, FACS; Dewey A. Christmas, MD; Eiji Yanagisawa, MD, FACS

It is often impossible to classify the disease process on the basis of endoscopic findings alone, but tissue biopsy and culture will lead to the appropriate diagnosis.

Changes in the nasalance of vowels within the first week following uvulopalatopharyngoplasty

February 24, 2016  |  Cheng-Chien Yang, MD; Ying-Piao Wang, MD, PhD; Chin-Wen Chang, MSc SLP

Abstract

We conducted a retrospective study to evaluate the short-term effect of uvulopalatopharyngoplasty (UPPP) on changes in the nasalance of five vowels: /a/, /ε/, /i/, /ɔ/, and /u/. Our study group was made up of 20 patients-15 males and 5 females, aged 16 to 57 years (mean: 37.3 ± 11.5)-who had undergone UPPP as a treatment for mild to moderate obstructive sleep apnea. Nasometry was used to obtain nasalance scores in all patients on the morning of the operation (day 1) and subsequently on day 4 or 5 (mean: 4.5 ± 0.5). Preoperatively, nasalance scores were highest for /i/ (mean: 29.8 ± 12.6) and /a/ (mean: 24.1 ± 10.3). After the operation, nasalance scores for all five studied vowels increased; they were highest for /i/ (mean: 40.7 ± +17.8) and /ε/ (mean: 30.0 ± 10.8). The increases in the nasalance of /i/, /ε/, and /u/ were statistically significant (p < 0.05). Our findings indicate that UPPP has a significant impact on nasalance immediately after surgery.

Novel injection technique into the interarytenoid area to treat dysphagia

February 24, 2016  |  Meghan Brooking, DO; Amanda Hu, MD, FRCSC; Robert T. Sataloff, MD, DMA, FACS

Augmentation of the interarytenoid space is a simple and innovative alternative to the traditional paraglottic space injection.

Blood flow to a hemorrhagic vocal fold mass

February 24, 2016  |  Jaime Eaglin Moore, MD; Natalie Krane, MD; Robert T. Sataloff, MD, DMA, FACS

While the value of treatment of the vessels that feed an area of mass formation seems self-evident, the wisdom of treating draining vessels has not been established.

Laser myringoplasty for tympanic membrane retraction

February 24, 2016  |  Brian S. Chen, MD; John W. House, MD; James V. Crawford, MD

Only selected patients are good candidates for this procedure. Patients who are able to lift their TM with the Valsalva maneuver are ideal.

Cavernous hemangioma of the submandibular gland with parapharyngeal extension in an adult: Case report

February 24, 2016  |  Roya Azadarmaki, MD; Matthew T. Then, MD; Rohit Walia, MD; Miriam N. Lango, MD

Abstract

Cavernous hemangiomas of the submandibular gland are rare. Signs and symptoms typically resemble those of sialolithiasis and chronic sialadenitis. If a lesion extends into the parapharyngeal space, otalgia and sore throat can result. Spontaneous regression is not a characteristic of cavernous hemangiomas. Surgical excision is a management option. We report the case of an adult with a submandibular gland cavernous hemangioma with parapharyngeal extension.

A twin-center study of nasal tip numbness following septorhinoplasty or rhinoplasty

February 24, 2016  |  Marie-Claire Jaberoo, MRCS; Neil De Zoysa, MRCS; Nishchay Mehta, MRCS; Vyas Prasad, FRCS(ORL-HNS); Rebecca Heywood, MRCS; Hesham Saleh, FRCS(ORL-HNS); Joe Marais, FRCS(ORL-HNS)

Abstract

Nasal tip numbness is a recognized postoperative complication after septorhinoplasty and rhinoplasty. We performed a twin-center retrospective study to determine the incidence of short- and long-term (>6 mo) nasal tip numbness after these procedures, and we studied several variables that might have been associated with this complication. Our study group was made up of 65 patients-31 males and 34 females, aged 15 to 67 years (mean: 30.5). Septorhinoplasty had been performed in 52 patients and rhinoplasty in 13; all surgeries were performed by two different surgeons at two different centers. There were 50 closed (endonasal) surgeries and 15 open surgeries. Follow-up phone calls made 6 to 37 months postoperatively revealed that 17 patients had experienced postoperative nasal tip numbness (26.2%); there were 10 cases of short-term numbness (15.4%) and 7 cases of long-term numbness (10.8%). Numbness resolved within 2 weeks in 8 of the 10 short-term patients. Of the 7 cases of long-term numbness, 6 patients reported severe numbness beyond 8 months, and 1 had mild numbness for at least a year. We found no association between the incidence of numbness and the type of surgery, the particular surgeon, or the particular center where the surgery had been performed. We did find that there was an association between long-term numbness and the open procedure, but it was not statistically significant. We discuss the possible mechanisms that might cause numbness in cases when the external nasal nerve is not cut. We believe it is important to include a discussion of the risk of nasal tip numbness during preoperative consultations and when seeking informed consent.

External auditory canal stenting with nonlatex glove and Gelfoam

February 24, 2016  |  Judy C. Pan, MD; Tucker M. Harris, MD

Abstract

External auditory canal stenosis, although uncommon, is a condition that is sometimes encountered by otolaryngologists. This condition has been shown to result from inflammatory changes that may be incited by many different causes. Various methods of stenting the canal open postoperatively have been described. We describe a readily accessible and inexpensive method of stenting the canal open postoperatively. The technique presented has been used effectively in all age groups at our institution, in cases ranging from trauma to postmastoidectomy procedures.

Resolution of vocal fold leukoplakia during erlotinib treatment for lung cancer

February 24, 2016  |  David O. Francis, MD, MS; Stephanie Misono, MD, MPH; Jessica Somerville, MD; Andrew McWhorter, MD; C. Gaelyn Garrett, MD

Abstract

Treatment of vocal fold leukoplakia is complicated because it is associated with a high rate of recurrence after excision and it has the potential for progression to malignancy. Authors have presented different approaches to management, one of which is directed serial excisional biopsies. Ideally, a topical or systemic agent could be administered to eradicate this troublesome condition. We present the case of a patient with an 8-year history of vocal fold leukoplakia treated with directed serial biopsies who was subsequently diagnosed with non-small-cell lung cancer and treated with erlotinib. He experienced a complete resolution after 2 months of erlotinib therapy for his lung cancer. Immunohistochemistry confirmed that his lesion exhibited a much higher than normal expression of epidermal growth factor receptor (EGFR), which supports the idea that EGFR antagonism may combat EGFR-avid leukoplakia. However, we caution that the clinical observation made herein is an association and should not be misconstrued as a recommendation regarding the safety, efficacy, or economy of using erlotinib for the treatment of vocal fold leukoplakia.

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