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Older siblings are at increased risk for foreign bodies

September 18, 2017  |  Laura H. Swibel Rosenthal, MD; Matthew R. Bartindale, MD; Zachary C. Fridirici, MD; Natalie A. Papillon, BS


A prospective, case-control study was performed to describe the role that siblings play in foreign bodies of the head and neck and to recognize situations in which children are most at risk for foreign bodies. Any child or adolescent (0 to 17 years old) with a foreign body removed from the head or neck was included. The data collected included location of the foreign body, location of acquisition (e.g., home), and the number of and ages of siblings. Controls were matched by age, sex, and location of removal (clinic, operating room, or emergency department). Thirty-four patients were enrolled (20 male, 14 female). The average age was 5.25 years (range: 10 months to 15 years). The average age of patients with foreign bodies in the ear was 5.98 years (n = 23), esophagus 4.34 years (n = 6), and nose 2.97 years (n = 5). Nineteen (56%) of the foreign bodies were acquired at home and 17 (50%) under supervision by parents. Children with a younger sibling have a significantly increased risk of acquiring a foreign body compared with children without a younger sibling (odds ratio = 4.00, p = 0.04). We conclude that although acquisition of foreign bodies should become less common as children mature, older siblings (i.e., children who have a younger sibling) are at increased risk for foreign body acquisition. Most foreign bodies are acquired at home under supervision by parents. Increased awareness of this finding may help prevent foreign bodies in the head and neck.

Bacterial cellulose as a new graft model for the Turkish delight technique in rhinoplasty: An experiment in 20 rats

September 18, 2017  |  Sevim Aydinli, MD; Sultan Biskin, MD; Aykut Erdem Dinc, MD; Yusuf Orhan Ucal, MD; Nilufer Kandemir, MD; Ishak Ozel Tekin, MD


We conducted an experiment to investigate the effectiveness of bacterial cellulose, a new graft material, in correcting and preventing dorsal nasal disorder in rhinoplasty. The experiment was performed on 20 Wistar albino rats. The rats were evenly divided into two groups: a fascia group and a cellulose group. In the fascia group, grafts from the conchal cartilage were removed, shredded, and then wrapped in temporal muscle fascia. In the cellulose group, shredded cartilage was wrapped in the bacterial cellulose. These shredded gristle grafts, which were also placed in a subcutaneous area at the back of the rats, were excised after 60 days. We then performed histopathology to compare the health and integrity of the cartilage and the degree of vascularization, fibrosis, and chronic inflammation in the two groups. We found a significantly greater degree of vascularization (p = 0.004) and fibrosis (p = 0.005) in the fascia group and a significantly greater degree of chronic inflammation (p = 0.023) in the cellulose group. We found no statistically significant difference between the two groups in terms of cartilage health and integrity. Our results suggest that bacterial cellulose grafting may play a role as an alternative to fascia grafting for the wrapping of shredded cartilages in Turkish delight grafting, but further investigation is needed.

Surgical trainees and powered-drill use do not affect type I tympanoplasty hearing outcomes

September 18, 2017  |  David T. Kent, MD; David H. Chi, MD; Dennis J. Kitsko, DO


The purposes of this study were to determine if use of a powered drill or trainee involvement during tympanoplasty is associated with a decline in sensorineural hearing, as well as to examine whether trainee involvement affected tympanic membrane (TM) closure rates. This study was a chart review (February 2006 to October 2011) of 172 pediatric otolaryngology patients undergoing type I tympanoplasty for TM perforation of any etiology at a tertiary-care pediatric otolaryngology practice. Data collected included air conduction (AC) at 250 to 8,000 Hz, speech reception thresholds, bone conduction (BC) at 500 to 4,000 Hz, and air-bone gap (ABG) at 500 to 4,000 Hz. Rates of surgical success did not change significantly if a trainee assisted during surgery (69.6% with an assistant vs. 77.4% without; p = 0.297). AC hearing was not found to be significantly different between the two groups preoperatively or postoperatively at 250, 500, 1,000, 2,000, 4,000, or 8,000 Hz (p > 0.05). There were no significant differences in AC hearing outcomes between patients in whom a surgical drill was used and those in whom no drill was used (p > 0.05). BC and ABG did not change significantly at any frequency (p > 0.05). In conclusion, no correlation between high-frequency hearing loss and use of a powered drill for canalplasty during type I tympanoplasty was found in this pediatric population. No significant difference was found in surgical success rates or AC hearing outcomes when a surgical trainee was present.

TNF-Alpha inhibitor as a cause of refractory suppurative laryngitis and rhinosinusitis

September 18, 2017  |  Sevtap Akbulut, MD; Lyndsay L. Madden, DO; Berrylin J. Ferguson, MD, FACS; Clark A. Rosen, MD, FACS

Discontinuation of TNF-α inhibitors is recommended in patients with bacterial infections requiring antibiotic therapy or those with severe upper respiratory infection.

Surgicel use in control of primary postadenoidectomy bleeding

September 18, 2017  |  Mohammad Waheed El-Anwar, MD; Ahmad Abdel Fattah Nofal, MD; Ashraf Elmalt, MD


Although postadenoidectomy bleeding is a rare complication, it is serious and potentially fatal. Postnasal packing and cautery of the adenoid bed are the most popular methods of controlling postadenoidectomy bleeding. Many hazards and complications may arise from traditional nasopharyngeal packing and nasopharyngeal cautery. In this case series, oxidized regenerated cellulose (Surgicel Nu-Knit; Ethicon; Somerville, N.J) was inserted and used as postnasal packing to control primary postadenoidectomy bleeding in 9 cases after conventional curettage adenoidectomy. All patients underwent nasophayngoscopic examination with a 0° rigid telescope to re-curette if any remnant was still present, and were repacked with appropriate size ribbon gauzes for at least 15 minutes before applying Surgicel. Surgicel succeeded in controlling primary postadenoidectomy bleeding in all cases, with no need for any further intervention. At the 1-month follow-up, no complications were reported. We conclude that Surgicel postnasal pack effectively controls primary postadenoidectomy bleeding. Its many advantages make it superior to other traditionally used material. It is readily available, tolerable, relatively inexpensive, hemostatic, adhesive, freely reshaped, bactericidal, causes no granulation reaction, has no need to be removed, and the patient does not need to be in the ICU or sedated.

Comparison of clinical outcomes using a Piezosurgery device vs. a conventional osteotome for lateral osteotomy in rhinoplasty

August 24, 2017  |  Bulent Koc, MD; Eltaf Ayca Ozbal Koc, MD; Selim Erbek, MD


Our aim for this study was to evaluate and compare the clinical outcomes in patients who underwent lateral osteotomy with a Piezosurgery device or a conventional osteotome in open-technique rhinoplasty. This cohort trial involved 65 patients (36 women and 29 men; average age: 23.6 ± 5.71 yr) who underwent surgery between May 2015 and January 2016. Piezosurgery was used for lateral osteotomy in 32 patients, whereas 33 patients underwent conventional external osteotomy. These 2 groups were compared for duration of surgery, perioperative bleeding, postoperative edema, ecchymosis, pain, and patient satisfaction on the first and seventh postoperative days. The Piezosurgery group revealed significantly more favorable outcomes in terms of edema, ecchymosis, and hemorrhage on the first day postoperatively (p < 0.001 for all). Similarly, edema (p = 0.005) and ecchymosis (p < 0.001) on the seventh postoperative day also were better in the Piezosurgery group. Hemorrhage was similar in both groups on the seventh postoperative day (p = 0.67). The Piezosurgery group not only experienced less pain on the first postoperative day (p < 0.001), but these patients also were more satisfied with their results on both the first and seventh postoperative days. Results of the present study imply that Piezosurgery may be a promising, safe, and effective method for lateral osteotomy, a critical step in rhinoplasty. The time interval necessary for the learning curve is counteracted by the comfort and satisfaction of both patients and surgeons.

Use of sialendoscopy as an aid to identify a large retained foreign body

August 24, 2017  |  Christopher J. Britt, MD; David Hyman, MD; Gregory K. Hartig, MD


We describe the novel use of sialendoscopy in a 51-year-old man to identify a large and long-standing foreign body (wood) within the facial soft tissues that had eluded detection on previous imaging and surgical exploration. The identification of this foreign body was elusive on both computed tomography and magnetic resonance imaging, illustrating the limitations of imaging in identifying vegetable matter within soft tissues.

25 years of powered endoscopic transnasal sphenoidotomy

August 24, 2017  |  Dewey A. Christmas, MD; Joseph P. Mirante, MD, MBA, FACS; Eiji Yanagisawa, MD, FACS

Endoscopic transnasal sphenoidotomy requires good hemostasis in the operative field.

Modified two-handed transnasal endoscopic surgery: Innovative instrument design and an experimental canine study

August 24, 2017  |  Guodong Feng, MD; Zhiqiang Gao, MD; Xu Tian, MD; Yuan Zhuang, MD; Wei Lv, MD


This study was conducted to design new instruments to solve the current issues of one-hand control and the obscuring of the endoscope by blood during transnasal endoscopic surgery. An endoscope holder and an electronically controlled irrigation-suction system were designed and manufactured. The feasibility and effectiveness of the designed instruments and operation models were verified in a model transnasal endoscopic surgery procedure performed on a mongrel dog. During the operation, one hand was used to perform the operation and move the endoscope, and the other hand was used for irrigation and suction to keep the surgical field and the endoscope clear. The combined use of an endoscope holder and an electronically controlled irrigation-suction system facilitates single-surgeon bimanual transnasal endoscopic surgery in a model surgical procedure. The clinical value of this technique warrants further research.

Nasal cavity tumefactive fibroinflammatory lesion mimicking recurrent mucoepidermoid carcinoma

August 24, 2017  |  Daniel Thomas Ginat, MD, MS; Elizabeth Blair, MD

The diagnostic imaging features of tumefactive fibroinflammatory lesions can mimic those of neoplasms.