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Markers of proliferation and cytokeratins in the differential diagnosis of jaw cysts

September 18, 2017  |  Nikola D. Zivkovic, PhD; Dragan S. Mihailovic, PhD; Milos S. Kostic, PhD; Ana S. Cvetanovic, MD; Zaklina Z. Mijovic, PhD; Maja V. Jovicic Milentijevic, PhD; Tijana V. Dencic, MD

Social media in otolaryngology-head and neck surgery

September 18, 2017  |  Modupe Oyewumi, MD; John Lee, MD, MSc, FRCSC; Allan Vescan, MD, FRCSC


The objective of this study was to assess the current use of social media tools within Canadian otolaryngology-head and neck surgery (OHNS) programs and to assess the interest within these programs to integrate social media for networking, social, and educational programs. A prospective study from September 2013 to February 2014 was performed involving residents and faculty in Canadian OHNS programs. A 26-item questionnaire was created and sent to staff and resident physicians who met the study inclusion criteria using an online survey tool (surveymonkey.com). There were 101 respondents for a 10% response rate. More than half (58.4%) of respondents reported use of social media for personal and/or professional matters. Residents and junior faculty physicians 39 years and younger were more likely to have social media accounts and used them more frequently than their older counterparts. Among staff physicians, pediatric otolaryngologists had the highest rate of use, and otologists exhibited the lowest rate. Cellular phones were the most commonly used devices to access social media sites. Fewer than 35% of social media users failed to separate their personal and professional accounts. Although OHNS trainees and practicing physicians identified the potential benefits of social media tools in their specialty, most were unsure how to apply these tools to their practice. Ours is the first study to assess social media use in OHNS. Otolaryngologists are currently using social media; however, their application as a communication and educational tool in otolaryngology remains to be defined.

Long-standing, near total tympanic membrane perforation

September 18, 2017  |  J. Scott Greene, MD, FACS

Although most spontaneous perforations heal, repeated ruptures and chronic suppuration can lead to permanent perforations.

Congenital ear malformations: Effectively correcting cryptotia with neonatal ear molding

September 18, 2017  |  Collin Rozanski, BA; Joseph J. Rousso, MD

Cryptotia is a relatively common congenital ear malformation that can be difficult to correct with surgery. Treatment should be started before the first 6 weeks of life.

Ear fetal rhabdomyoma

September 18, 2017  |  Lester D. Thompson, MD

The soft tissues of the orbit, ear, and oral cavity are the most frequent sites of involvement, although adult-type rhabdomyomas are more common in the parapharyngeal and laryngeal spaces.

Hereditary hemorrhagic telangiectasia-laser treatment of epistaxis

September 18, 2017  |  Gorazd Poje, MD; Marcel Marjanovic Kavanagh, MD


Hereditary hemorrhagic telangiectasia (HHT) is a rare, autosomal dominant disorder characterized by recurrent epistaxis, telangiectasias, and multiorgan vascular dysplasia. Various modalities exist for the treatment of HHT-related chronic epistaxis, although no method is preferred over another. The aim of this study was to review the effectiveness of diode laser photocoagulation in the treatment of epistaxis in patients with HHT. The study included 17 patients (7 men, 10 women) treated with diode laser photocoagulation from year 2008 to 2012. All patients met the CuraƧao criteria for a diagnosis of HHT. Patients were followed for 1 year. Treatment success was assessed using a custom questionnaire and total blood counts. After laser photocoagulation, the frequency and intensity of bleeds were reduced significantly and average hemoglobin concentrations improved at the 4-month assessment. After laser treatment, no patient required septodermoplasty; therefore, we suggest that every patient with HHT should be treated with laser photocoagulation. Diode laser treatment is a simple and effective procedure that should be considered when treating HHT.

Study of factors responsible for recidivism in allergic fungal rhinosinusitis

September 18, 2017  |  Bipin Kishore Prasad, MS


Patients with allergic fungal rhinosinusitis (AFRS) are typically atopic and immunocompetent. Despite combined modality treatment based on surgery and immunomodulation, the potential for recidivism is well recognized. A study was conducted in a military hospital in India to identify the factors responsible for recidivism in AFRS and to suggest measures to overcome it. Sixty patients with AFRS (42 new cases and 18 cases that required revision surgery) were managed between January 2009 and July 2013. Patients underwent endoscopic, radiologic, and laboratory evaluation for AFRS followed by functional endoscopic sinus surgery. Each patient received oral prednisolone, 1 mg/kg/day, for 1 week preoperatively and 0.5 mg/kg/day for 4 weeks postoperatively. A randomly selected group of 30 patients (group A) received oral prednisolone 0.4 mg/kg/day for the next 4 weeks, tapered to 0.2 mg/kg/day for the next 2 months and to 0.1 mg/kg/day for the last 2 months. The drug was stopped after 6 months. In the remaining 30 patients (group B), oral prednisolone was tapered within 2 months. Topical steroid sprays were advised in all patients. Recidivism was observed in 12 of 42 (28.6%) patients presenting for the first time with AFRS: 9 patients from group B (30%) and 3 patients from group A (10%). Besides inadequate postoperative oral steroid therapy, suboptimal functional endoscopic sinus surgery, noncompliance with intranasal sprays, nonadherence to Kupferberg staging, inadequate follow-up, failure of surgeons to impart health education to patients, and unavailability of ENT consultation in rural belts were found to be factors causing recidivism.

Maxillary sinus mucoceles and other side effects of external-beam radiation in the pediatric patient: A cautionary tale

September 18, 2017  |  Anthony Sheyn, MD; Tate Naylor, MD; Felicity Lenes-Voit, MD; Eric Berg, MD


A sinonasal mucocele can develop after the obstruction of a sinus ostium, which can occur secondary to trauma, infection, a neoplasm, or an iatrogenic cause. These mucoceles typically arise in the frontal and ethmoid sinuses. Sinonasal mucoceles are epithelium-lined cysts that can gradually expand to fill a paranasal sinus. They can present with ophthalmologic, rhinologic, and neurologic symptoms. There are reports in the literature of sinonasal mucocele development after radiation for nasopharyngeal carcinoma. However, these cases are rare; when they do occur, they tend to arise in the sphenoid sinus. We describe the case of a 21-year-old man who had undergone external-beam radiotherapy for a right maxillary sinus rhabdomyosarcoma at the age of 4 years and who subsequently developed bilateral maxillary sinus mucoceles and multiple other known complications of radiation therapy. To the best of our knowledge, this is the first case of postirradiation bilateral maxillary sinus mucoceles to be reported in the literature.

Management decisions for Zenker diverticulum in the elderly

September 18, 2017  |  Karen Kost, MD, FRCSC; Kourosh Parham, MD

Zenker diverticulum is primarily a geriatric condition, usually requiring surgical management.

Endoscopy-assisted Coblation for nasopharyngeal stenosis: A report of 2 cases

September 18, 2017  |  Omer Karakoc, MD; Bahtiyar Polat, MD; M. Timur Akcam, MD; Mustafa Gerek, MD


Acquired nasopharyngeal stenosis, the standard treatments for which carry a high risk of restenosis, is an uncommon complication of both velopharyngeal surgery and radiotherapy to the nasopharynx. We present the cases of 2 men, aged 41 and 52 years, who underwent surgical treatment for nasopharyngeal stenosis with endoscopy-assisted Coblation. The two surgeries lasted 23 and 18 minutes, respectively. Neither patient experienced any surgical complication, and a nasopharyngeal stent was not needed in either case. At follow-up 12 months postoperatively, both patients exhibited a patent nasopharyngeal passage. Endoscopy-assisted Coblation appears to be a safe, effective, and less painful option for the treatment of nasopharyngeal stenosis.