Rotenberg Brian W. Alsaffar Hussain Kandessamy Thileeban

AbstractBACKGROUND:Multiple options are available for the treatment of snoring. Our objective was to evaluate a palatal implant system in the treatment of snoring caused specifically by retrovelar collapse.STUDY DESIGN:Prospective long-term study comparing snoring outcomes pre– and post–soft palate implantation.METHOD:Snoring patients without significant sleep apnea were offered palatal implantation after assessment via strict inclusion/exclusion criteria. Snoring severity was rated by the bed partner, in a longitudinal fashion, using a Likert scale both in the preoperative and postoperative settings. Paired Student t-tests were used to compare the mean snoring severity preoperatively and at different points of time postoperatively up to 1 year and to compare patient's body mass indices over the study timeline.RESULTS:Data were obtained from 25 patients over a follow-up time of 1 year, for a total of 75 implants. A statistically and clinically significant improvement in the snoring was noted over the 52-week time period of the study in our patient population (mean preoperative score = 9.5, mean 52-week postoperative score = 5.0; p < .001). Body mass index did not significantly change over the duration of the study.CONCLUSION:In our patient population, soft palate implantation was a safe and effective technique for achieving a subjective improvement in the intrusiveness of snoring as noted by the bed partner.

Civelek Senol Cakir Burak Emre Ismet Ozcelik Muge Turgut Suat

AbstractOBJECTIVE:The aim of this study was to evaluate the advantages and feasibility of using the GlideScope video laryngoscope (GSVL) (Saturn Biomedical Systems, Burnaby, BC) in radiofrequency tongue base reduction for patients with obstructive sleep apnea syndrome (OSAS).METHODS:Patients suffering from mild to severe OSAS associated with predominant tongue base obstruction (grade 3–4 Mallampati score) confirmed with physical examination who applied to our clinic during the first half of 2007 were included in our study. Seven-watt bipolar radiofrequency was applied to each patient's tongue base assisted by the GSVL at five to seven different locations for 30 to 35 seconds, resulting in energy application in a range of 210 to 245 J. All operations were carried out by the same surgeon, and patients were observed for 15 days postoperatively for any complications.RESULTS:Twelve patients were included in our study. Six of our patients were male and the other six were female. Each patient underwent a session of GSVL-assisted tongue base radiofrequency with a mean energy application of 210 to 245 J via five to seven punctures. The use of the GSVL assisted in a more thorough observation of tongue base anatomy, which aided in our aim to avoid the neurovascular bundle. The use of the GSVL during tongue base radiofrequency surgery creates a safer operation site and allows the surgeon to feel more confident during the procedure. The fact that we encountered no postoperative complications endorses our theory.CONCLUSION:The use of the GSVL in tongue base radiofrequency application not only creates a safer operative site and makes the procedure more uncomplicated but also could be an effective method that could be used in teaching hospitals for the education of otolaryngology surgeons regarding the tongue base radiofrequency procedure.

Wang Ling-Feng Tai Chih-Feng Kuo Wen-Rei Chien Chen-Yu

AbstractOBJECTIVES:To review our experience with deep neck infections and identify the risk factors for developing complications and prolonged hospitalization.SUBJECTS AND METHODS:We analyzed the prospectively collected database of 439 patients with deep neck infections between January 1996 and July 2007 at a single institution. Their demographic data, duration of hospitalization, etiology, underlying systemic disease, bacteriologic and radiologic studies, complications, and treatment outcome were reviewed and analyzed. Patients with superficial abscess or cellulitis, necrotizing fasciitis, and peritonsillar abscess were excluded.RESULTS:Dental infection and upper airway infection remained the two most common etiologies. Coexisting head and neck malignancy was found in eight cases. Patients with systemic diseases and a C-reactive protein value of more than 100 μg/mL tend to develop complications, resulting in prolonged hospitalization.CONCLUSION:We should pay more attention to those patients with systemic diseases or C-reactive protein values more than 100 μg/mL. The current study represents the largest and longest analysis of deep neck infection in the available literature.

Leclerc Jacques E.

Al-Dhahri Saleh Fahad Al-Ghonaim Yazeed A. Terkawi Abdullah Sulieman

AbstractOBJECTIVE:To evaluate the accuracy of measurement of different parathyroid hormone (PTH) and corrected calcium (cCa) levels at different times as early predictors of postthyroidectomy hypocalcemia.DESIGN:A retrospective cohort study.SETTING:King Fahad Medical City, Riyadh, Saudi Arabia, between January 2006 and March 2009.METHODS:Patients who underwent total or completion thyroidectomy were followed until hospital discharge. Patients were observed clinically for hypocalcemia; at the same time, the postoperative PTH and cCa levels after 6, 12, and 20 hours and then twice daily were recorded.MAIN OUTCOME MEASURES:Postthyroidectomy hypocalcemia.RESULTS:Seventy-nine of 116 patients were enrolled in our study; 26.60% of them had hypocalcemia. PTH measurement at 6 hours postoperatively was an excellent predictor of hypocalcemia (area under the curve = 0.95, 95% CI 0.88–0.99). The mean PTH at 6 hours for hypocalcemic patients was 0.93 (± 0.60). A 1.7 pmol/L as a cutoff level of PTH at 6 hours has 95.2% sensitivity, 89.7% specificity, 76.9% positive predictive value (PPV), and 98.1% negative predictive value (NPV). On the other hand, a 2.1 mmol/L as a cutoff level of cCa has 81.0% sensitivity, 81.6% specificity, 65.3% PPV, and 90.9% NPV in predicting hypocalcemic patients.CONCLUSIONS:PTH measurement 6 hours after surgery with a cutoff level of 1.7 pmol/L is more accurate than serial calcium level measurement for early prediction of patients at risk of hypocalcemia. Thus, a single PTH measurement postoperatively will help in discharging patients safely within the first 24 hours, improving bed use and cost-effective care.

Jean Chen Kuan-chin Glicksman Jordan T. Haase Peter Johnson Marjorie Wilson Tim Fung Kevin

AbstractINTRODUCTION:Didactic head and neck anatomy teaching has been replaced by a novel self-directed, multimodal, and multidisciplinary approach at the Schulich School of Medicine and Dentistry (SSMD).OBJECTIVES:To describe the use of a novel teaching paradigm at SSMD and to enable readers to determine how this methodology may benefit medical students at other academic institutions and disciplines.DESIGN:Prospective cohort study.METHODS:The paradigm consists of multimedia learning modules to guide independent anatomy learning. Students received a case-based assignment based on the content of the learning modules to guide them through cadaveric dissections facilitated by a multidisciplinary team of surgeons and anatomists.MAIN OUTCOMES MEASURES:Primary outcome: Postcourse survey and mean scores comparison. The survey collected data, including demographics and previous anatomic and computer-assisted learning (CAL) experiences, and focused on measuring student perception of the proposed paradigm. Secondary outcome: Correlation of demographics.RESULTS:The paradigm was successfully implemented and warmly received, but it still requires further development. Although CAL allows increased individual engagement, students still enjoy and value lectures. In addition, students view instruction by surgeons in laboratories as the most valuable component of their anatomy teaching as it not only deepened the students' understanding of anatomic structures but also provided them with the clinical relevance. Technological innovations were welcomed by the students but have not replaced their appreciation of dissection and lecures.

Schwartz Joseph How Jacques Lega Iliana Cote Jeanne Gologan Olga Rivera Juan-Andres Garfield Natasha Zeitouni Anthony Payne Richard

AbstractOBJECTIVE:To assess the efficacy of ultrasound-guided thyroid fine-needle aspiration biopsies (USFNABs) performed in the office setting by an otolaryngologist and to evaluate the specimen adequacy of USFNABs performed in patients whose initial palpation-guided fine-needle aspiration biopsies (PGFNABs) were nondiagnostic.DESIGN:Retrospective chart review.SETTING:Royal Victoria Hospital–McGill University Health Centre, Montreal.METHODS:This is a retrospective analysis of 76 USFNABs performed by an otolaryngologist on consecutive patients over a 6-month period. Each patient had a previous nondiagnostic PGFNAB. Biopsies were performed using a 20-gauge fine needle with a Mylab25 Biosound Esoate ultrasound machine. Samples were then classified according to the adequacy of sample and pathologic findings.MAIN OUTCOME MEASURE:Specimen adequacy rate.RESULTS:Sixty-six patients underwent 76 USFNABs. The sample included 57 females and 9 males (mean age 51.1 and 55.4 years, respectively). The specimen adequacy rate was 90.8% (69 of 76). Among the adequate specimens, 2 (2.6%) were malignant, 6 (7.9%) were suspicious for malignancy, 43 (56.6%) were benign, and 18 (23.7%) were follicular or Hürthle cell lesions (indeterminate).CONCLUSION:Our experience demonstrates that USFNAB performed in the clinic by an otolaryngologist is a promising tool for improving specimen adequacy for nodules initially classified as nondiagnostic. USFNAB also avoids the need for radiologic consultation, thus improving efficacy in the workup of nodules.

Chau Jason K.M. Hoy Monica Tsui Ban Harris Jeffrey R.

AbstractOBJECTIVE:To compare minimally invasive parathyroidectomy (MIP) under local anesthesia (MIPULA) to minimally invasive parathyroidectomy performed under general anesthesia (MIPUGA) in terms of postoperative pain, postanesthetic side effects, patient satisfaction, and overall outcome.DESIGN:Prospective comparative cohort study.METHODS:Consecutive consenting patients presenting to a single surgeon's practice were enrolled into MIPULA or MIPUGA groups if inclusion criteria were satisfied. A standard anesthesia and surgical protocol was followed for all included patients. Subjective outcome measurements (pain, overall satisfaction, and other variables) were achieved through questionnaires. Objective outcomes were also measured.RESULTS:Seventy-four patients were enrolled: 58 in the MIPULA group and 16 in the MIPUGA group. Operative time and hospital stay were significantly shorter in the MIPULA group. Subjectively, the MIPULA group was significantly more ready for discharge versus the MIPUGA group. No significant difference in overall satisfaction between groups was noted. Biochemical cure and conversion (MIPULA to general anesthesia open exploration) rates for our cohort were 100% and 4%, respectively.CONCLUSIONS:MIPULA confers significantly shorter operative time and hospital stay with no significant difference in subjective postoperative pain, patient satisfaction, overall outcome, or cure rate when compared to MIPUGA. Provided that appropriate preoperative localization and surgical experience are present, MIPULA can be offered to patients as a safe and reasonable alternative to MIPUGA.

Guillemaud Jennifer P. Patel Rajan S. Goldstein David P. Higgins Kevin M. Enepekides Danny J.

AbstractOBJECTIVE:Although the literature suggests that a positive tumour margin on permanent section portends a poor oncologic outcome, the prognostic implication of microscopic tumour cut-through (ie, positive tumour margin on intraoperative frozen section) that is surgically revised to a negative final margin on permanent section is currently unclear. Therefore, this study aimed to analyze the influence of microscopic tumour cut-through on disease recurrence and survival and to establish clinicopathologic variables associated with tumour cut-through.DESIGN:A retrospective chart review.SETTING:The Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto.METHODS:Comprehensive clinicopathologic data were collected, including demography, clinical tumour staging (TNM), treatment, histopathologic details, recurrence, management, and follow-up.MAIN OUTCOME MEASURES:Local cancer control and disease-specific survival were the main outcome measures of interest. The Kaplan-Meier method was used to assess outcome measures by patient group, and the log-rank test was used to compare survival curves. Univariate and multivariate Cox proportional hazard regression analyses were used to test the association of various clinical factors and to identify independent prognostic factors of local control and disease-specific survival.RESULTS:Sixty-five patients met inclusion criteria for our study (37 males; median age 64.4 years). Both local control and disease-specific survival were statistically significantly reduced in patients with positive intraoperative frozen section despite revision to obtain negative margins (p < .05). Multivariate analysis showed that microscopic tumour cut-through independently predicted poorer local control and disease-specific survival (p < .05).CONCLUSIONS:This study in patients receiving primary surgery for oral squamous cell carcinoma shows that microscopic tumour cut-through on intraoperative frozen section independently portends a poorer oncologic prognosis, regardless of ultimate tumour margin pathology.

Singh Prabhjyot O'Connell Daniel Langille Moran Dziegielewski Peter Allegretto Michael Harris Jeffrey

AbstractBACKGROUND:Meticulous hemostasis is a critical and often time-consuming step of safe thyroid surgery. The LigaSure system (Valleylab, Boulder, CO) is a diathermy hemostasis method that fuses vessel walls to form a collagen seal. Previous studies have shown reduced operative times in thyroidectomy using the LS system. The primary objective of the study was to compare operative times using the LS system to conventional titanium clips and surgical ties (CLTs). Secondary outcomes included vocal cord dysfunction, scores on the Voice Handicap Index (VHI), postoperative hypocalcemia, and operative costs between the two groups.METHODS:Twenty-eight patients were block randomized to thyroidectomy with either the LS system or CLTs. Patient demographics, operative times, pre- and postoperative VHI scores, vocal cord endoscopy, and operative costs were collected on all patients. Patients were also monitored for clinically significant hypocalcemia postoperatively.RESULTS:The mean operative time for CLTs was 68.6 minutes (SD 14.56) versus 68.5 minutes (SD 27.47) for the LS system, which was not statistically significant. VHI scores differed between CLTs and the LS system for the postoperative score only: CLT 19.83 (SD 19.81) versus LS 6.57 (SD 10.83). This was statistically significant, with p = .041. No difference was detected for hypocalcemia rates or endoscopic vocal cord dysfunction. The operative cost for the LS system was $387.15 (SD $11.93) and for the CLTs was $73.60 (SD $27.72), which was statistically significant (p < .001).CONCLUSION:The use of the LS system in thyroidectomy did not reduce overall operative time by a clinically significant level, indicating limited utility in terms of cost reduction contradictory to current literature.

Douglas Catriona M. Malik Tass Swindell Ric Lorrigan Paul Slevin Nick J. Homer Jarrod J.

AbstractINTRODUCTION:Head and neck mucosal melanoma (MuM) is rare, comprising < 1% of all melanomas in Western Europe.METHODS:A retrospective analysis of case records of patients treated between 1965 and 2001 was carried out. (Survival outcomes were obtained from the case notes and cancer registry.) The median age of the 68 patients was 63 years (range 29–86 years). Thirty-nine percent were male, and 61% were female. (The minimum follow-up time was 15 months.) The two most common primary sites were the sinonasal complex (65%) and oral cavity (19%). Twenty-one percent of patients presented with metastases (nodal or distant). Fifty-five patients were treated with curative intent: 30 patients with primary radiotherapy and 25 patients with surgery ± postoperative radiotherapy.RESULTS:The overall survival was 22% at 5 years, and the cancer-specific survival was 32% at 5 years.CONCLUSION:MuM has a poor overall prognosis. Poor prognostic indicators are site at presentation and presentation with metastasis. This series is unique in that a significant proportion of patients were given primary radiotherapy as definitive treatment. Surgery may have advantages, particularly for oral cavity MuM. In contrast to previous reports, definitive radiotherapy is worthy of consideration as curative treatment.

Chin Christopher Franklin Jason Sowerby Leigh Fung Kevin Yoo John

AbstractOBJECTIVE:The goal of our study was to identify factors in intermediate-risk fine-needle aspiration (FNA) results that are predictive of malignancy.DESIGN:Retrospective chart review.SETTING:Head and neck oncology clinic at the London Health Sciences Centre.METHODS:A database of 665 patients who had received thyroid surgery between 2001 and 2007 was created. FNA biopsy data were collected for each patient, as well as pathologic, patient, and ultrasound data. Of the 665 patients, 302 FNA biopsies were considered intermediate risk, and these data were analyzed.MAIN OUTCOME MEASURE:Presence of malignancy.RESULTS:Intermediate-risk patients were significantly more likely to have a benign nodule if the width to length (W/L) ratio of their nodule was < 0.6. The relative risk was 5.64 (95% confidence interval [CI] 0.81–39.65) (p < .05). As well, patients who were in the intermediate-risk category were significantly more likely to have a malignancy if they were < 40 years old compared to those patients who were ≥ 40 years old.CONCLUSIONS:Both age and W/L ratio of a nodule can be used to help predict whether a nodule in an intermediate-risk patient is malignant. An intermediate-risk patient who has a W/L ratio < 0.6 can be treated conservatively based on the extremely low risk of malignancy (2.86%).

Chu Koung-Shing Tsai Cheng-Jing Lu I-Cheng Tseng Kuang-Yi Chau Siu-Wah Wu Che-Wei Lee Ka-Wo Kuo Wen-Rei Chiang Feng-Yu

AbstractOBJECTIVE:The objective of this study was to find a nondepolarizing muscle relaxant to replace succinylcholine during thyroid surgery with intraoperative neuromonitoring (IONM) because succinylcholine can cause severe adverse effects.DESIGN:Prospective study of 232 patients undergoing thyroidectomies.SETTING:A tertiary medical centre.METHODS:One hundred thirty-one patients received 0.5 mg/kg rocuronium (group R) and 101 patients received 0.5 mg/kg atracurium (group A) to facilitate electromyographic (EMG) endotracheal tube insertion. EMG signals were obtained from the vagus nerve before and after dissection of the recurrent laryngeal nerve and were defined as the V1 and the V2 signal, respectively. Accelerometry (twitch [% TW]) was used to monitor the quantitative degree of neuromuscular transmission at the adductor pollicis muscle.MAIN OUTCOME MEASURES:The amplitude (μV) of the V1 and V2 signals and the correlated degree of neuromuscular transmission (% TW).RESULTS:V1 and V2 signals were obtained from all patients successfully. The % TW at the V1 signal was significantly lower than that at the V2 signal in group R and group A. The mean recovery time from complete neuromuscular blockade to the initial twitch was 43.9 ± 11 minutes. Only in the subgroup in which the correlated TW was 0% while eliciting the V1 signal were the amplitudes of the V1 signals significantly lower than those of the V2 signal in both groups.CONCLUSIONS:A single dose (0.5 mg/kg) of rocuronium and atracurium was feasible for IONM during thyroid surgery. This study showed that 44 minutes after administration of these two muscle relaxants is adequate for eliciting an EMG signal from the vagus nerve.

Veyseller Bayram Aksoy Fadlullah Özturan Orhan Acar Hürtan Ertaş Burak Bayraktar Fatma Gulum Ivgin Soylu Erkan Selim Yıldırım Yavuz

AbstractOBJECTIVE:To compare a novel functional neck dissection technique that offers wider exposure and reduced morbidity compared to classic functional neck dissection, which is the gold standard for neck treatment of squamous cell carcinoma of the head and neck.STUDY DESIGN:A prospective, double-blind, controlled clinical study.SETTING:Fifty surgical neck dissections were performed on 25 patients diagnosed with laryngeal cancer.SUBJECTS AND METHODS (MAIN OUTCOME MEASURES):The open neck dissection technique was used on the primary tumour side (study group) and functional neck dissection was used on the other side (control group). Electromyographic measurements of the trapezius and sternocleidomastoid muscles and neurologic evaluations were performed preoperatively and at 1 and 6 months postoperatively. Also, the number and tumour stages of lymph nodes excised during neck dissection were evaluated by histopathologic examination as a measure of surgical efficacy.RESULTS:The electromyographic measurements of the study group at 1 and 6 months postoperatively were found to be superior to those of the control group, although the difference between the groups was not significant. The mean number of dissected lymph nodes was significantly higher in the study group than in the control group.CONCLUSION:The open functional neck dissection procedure described in this study allows wider exposure, reduces the acute morbidity associated with the spinal accessory nerve compared to classic modified neck dissection, and offers improved surgical efficacy with respect to lymphadenectomy.

Schultz Philippe Charpiot Anne Vautier Dominique Guilleré Florence Debry Christian

AbstractOBJECTIVE:The aim of this work is to present requirements and actual solutions to produce a laryngeal prosthesis.METHOD:Data were collected after a literature review and in the light of our work in that field.RESULTS:The conception of an artificial larynx requires biocompatibility studies to find the ideal biomaterial capable of being integrated in cervical environment and upper airway tracts. A hollow tube extending the trachea, surrounded by cervical tissue, and covered with epithelium on the endoluminal part would allow connecting the trachea to the tongue base. The biomaterial should be rigid, inert, non cytotoxic, and smooth to fulfill the physical necessities of the implant and to optimize its tolerance and colonization. Among all biomaterials tested, porous titanium seems to be the most interesting. To prevent aspiration, the creation of a laryngeal sphincter located over the superior part of the hollow tube is required. An opening and closing system, coordinated to respiration and swallowing, could be considered with valves. In proportion to the unavoidable wear and tear of the mechanism, the conception of a removable sphincter seems necessary. Moreover, this system could harbour a phonatory valve to generate the fundamental laryngeal tone.CONCLUSION:Although any laryngeal sphincter is currently available, the biocompatibility studies already performed allow disposing of biomaterial to create a laryngeal prosthesis.

Hu Amanda Parnes Lorne S.

AbstractOBJECTIVE:To review our 10-year experience of endolymphatic sac surgery (ESS) for intractable Meniere disease (MD).DESIGN:Retrospective chart review and survey.SETTING:Tertiary care centre.METHODS:Patients presenting for ESS from 1998 to 2007 were reviewed using the 1995 American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) guidelines. A quality of life (QOL) questionnaire was mailed out using the Dillman method.MAIN OUTCOME MEASURES:(1) 1995 AAO-HNS hearing stage, vertigo class, and functional level; (2) complications and secondary treatments; (3) a 40-question, disease-specific, validated QOL questionnaire (Meniere's Disease Outcome Questionnaire).RESULTS:Thirty patients (33 ears) had ESS (63.6% male, mean age 49 years, mean follow-up 30.6 months). Vertigo control was 35.5% class A, 29.0% class B, 6.5% class C, 0% class D, 3.2% class E, and 25.8% class F. If class A and B are considered successful, then 64.5% were successful. Hearing stage improved in 14.8%, remained the same in 51.9%, and worsened in 33.3%. Average preoperative functional level was 4.3 and postoperative level was 3.5 (p = .0016). Secondary treatment after ESS was performed in 26%. Three patients (10.0%) had profound sensorineural hearing loss. Twenty-five questionnaire responses (75.8%) were received. There was a significant increase in QOL scores (p = .000001), and 80% had an improvement in QOL scores.CONCLUSIONS:ESS is a surgical option for MD that offers relief from vertigo in selected patients, but patients need to be cautioned about the risk of hearing loss and the requirement for subsequent destructive treatment in a significant proportion of cases.

Quddusi Taeed Blakley Brian W. Meen Eric Berard Sylvie Dewji Zameel

AbstractINTRODUCTION:This study compares the effects of sodium thiosulphate (STS) and normal saline on the prevention of hearing loss.SETTING:Animal research laboratory.METHODS:Sixteen mice were randomized to receive intraperitoneal injections of either normal saline or STS. Auditory brainstem response testing was used to determine baseline and posttreatment hearing thresholds over the course of 1 year.RESULTS:Compared with saline, treatment with STS resulted in a statistically significant improvement in click and pure-tone thresholds until the end of the year.CONCLUSION:STS can significantly delay hearing loss associated with age in this murine model.

Peng Jian-Hua Wang Jing-Bo Chen Jian-Hu

AbstractOBJECTIVE:To investigate effects of recreational noise exposure on olivocochlear efferent function.METHODS:efferent suppression of DPOAEs and acoustic reflexes were tested in 32 young personal listening device users with normal hearing and compared with that of healthy, non–noise-exposed young adults.RESULTS:The results showed that the efferent suppression of DPOAEs was mainly at low frequencies (0.75 and 1.0 kHz) in both groups and the efferent suppression of DPOAEs and acoustic reflexes in the noise exposure group was slightly lower than that in the control group, with no significant differences.CONCLUSIONS:Our results revealed that there were no differences in DPOAE changes or medial olivocochlear bundle function between normal-hearing subjects exposed to recreational noise and controls and suggest that recreational noise has different effects on olivocochlear efferent reflex strength compared with occupational noise exposure.

Tu Tzong-Yang Yang An-Hung

AbstractOBJECTIVE:This study was performed to evaluate the histologic changes in the regenerated cartilage in the previously established rabbit tympanic bullae obliteration model.DESIGN:Experimental study.SETTING:Tertiary otolaryngology care centre.METHODS:The histologic sections of grafted cartilage were examined 4 weeks and 2 and 4 months after surgery.MAIN OUTCOME MEASURES:The chondrogenesis and osteogenesis ratios indicated by the cross-sectional area ratios of the newly formed cartilage and bone to the originally grafted cartilage were calculated and compared.RESULTS:Remarkable neochondrogenesis from the perichondrium of grafted auricular cartilage was found shortly after surgery. New cartilage appeared from the preserved perichondrium at the end of 4 weeks. Some areas of rapid division, maturation, and hypertrophy of the chondrocytes in the new cartilage were noted 4 weeks to 2 months after surgery. A process resembling endochondral ossification by replacement of new cartilage with immature woven bone was observed 2 months postoperatively. The remodeling process that substituted the immature woven bone with mature lamellar bone was seen 4 months after grafting. The chondrogenesis and the osteogenesis ratios were significantly different at the ends of 4 weeks and 2 and 4 months (p < .05).CONCLUSION:The histologic changes in the regenerated cartilage in the tympanic bullae are similar to those in the healing process of bone fracture in the ossification process of cartilage and the remodeling process of bone tissue. In the clinical viewpoint, these findings may be potentially useful in the improvement of cartilage obliteration of mastoid cavity during cholesteatoma surgery.

Amoodi Hosam Bance Manohar Thamboo Andrew

AbstractA retrospective analysis of 35 skull base patients with no history of eustachian tube dysfunction who had magnetic resonance imaging at our institution between 2006 and 2007 was conducted. The fat pad of Ostmann surface area, the eustachian tube medial cartilage, and the tensor veli palatini muscle surface area were measured in all scans. The change in anatomic structures with age was compared and showed no parameter changes except for the Ostmann fat pad, which decreased in size with age (correlation coefficient = 0.0629). There was no statistical significance between males and females in all parameters.

Gokcan M. Kursat Kucuk Babur Yazicioglu Duygu Tuzuner Oncul Aysegul

AbstractOBJECTIVE:We present the short-term treatment results of a modified technique in transoral endoscopic condyle repair.DESIGN:A pilot prospective study from April 2006 to November 2007.SETTING:Ankara University Medical School Teaching Hospital.METHODS:Four patients with subcondylar fracture were treated with transoral endoscopic condyle repair. Preliminary restoration of the occlusion was provided with maxillomandibular fixation. Four hands endoscopic sinus surgery principles were adapted to transoral endoscopic condyle repair.MAIN OUTCOME MEASURES:Providing condylar stabilization with good occlusion and temporomandibular joint function was expected from treatment.RESULTS:Open reduction and internal fixation were achieved in all patients. Condylar stabilization was confirmed by intraoperative endoscopic findings and postoperative panoramic radiographs. Uneventful healing with good occlusion and temporomandibular joint function were noted in 3 to 14 months of follow-up.CONCLUSION:Endoscope-assisted minimal invasive procedures have been taking more part in head and neck soft tissue and trauma surgery. The cost of instruments and technical difficulties are the main constraints of endoscopic techniques. In this study, we present a practical way to perform transoral endoscopic condyle repair using the otolaryngologist's standard sinus surgery endovisual equipment and a titanium miniplate system. With the addition of a surgical hand, successful treatment results could be achieved with reduced cost.

Morrissey Andrew T. O'Connell Daniel A. Garg Sipi Seikaly Hadi Harris Jeffrey R.

AbstractOBJECTIVE:To investigate the use of anterolateral thigh flaps versus radial forearm free flaps for the reconstruction of laryngopharyngectomy defects in a prospective, randomized study.METHODS:Nineteen patients who were to undergo laryngopharyngectomy were randomized into either anterolateral thigh or radial forearm groups. The primary outcome measure was complication rate (eg, flap failure, fistula formation, pharyngeal stenosis). Secondary outcome measures included donor-site morbidity (limb function, cosmesis, pain).RESULTS:There was a significant (p = .04) increase in reconstructive complications in the anterolateral thigh group, including esophageal stenosis and pharyngeal fistulae. There was no significant difference in donor-site complications.CONCLUSION:There is an increased free flap complication rate without decreased flap donor-site morbidity when using the anterolateral thigh flap to reconstruct laryngopharyngectomy defects. As such, we recommend the radial forearm free flap as the preferred flap for reconstruction of laryngopharyngectomy defects.

Yılmaz Süleyman Kocaman Akbay Buket Yıldızbaş Şahnur Güc¸lü Ender Yaman Hüseyin Yalc¸ın Sezen Gülbin

AbstractOBJECTIVE:To search the efficacy of using Merocele (Medtronic, Minneapolis, MN) soaked with 5 mL of levobupivacaine hydrocloride as a nasal pack in control of postoperative pain after septoplasty.DESIGN:The study was designed as a prospective, double-blind, randomized, controlled study. Forty-one patients who underwent septoplasty operation were included in the analysis.SETTING:A tertiary referral hospital in Turkey.MATERIAL AND METHODS:Forty-one patients undergoing septoplasty were divided into two groups. At the end of the operation, Merocele packs were placed inside the nasal cavity. In the levobupivacaine group, each Merocele pack was soaked with 5 mL of levobupivacaine hydrochloride (25 mg/10 mL), and in the control group, Merocele packs were soaked with 5 mL of saline.MAIN OUTCOME MEASURES:Postoperative pain levels were recorded using a visual analogue scale (VAS score, 0–100) at 30 minutes and 1, 2, 8, 12, and 24 hours.RESULTS:We did not find any significant difference between groups regarding age, gender, American Society of Anesthesiologists status, and body mass index. Postoperative VAS values at 30 minutes and 1, 2, 8, and 12 hours were significantly lower in the levobupivacaine group compared with the control group (p < .05). The need for supplemental analgesia was significantly lower in the levobupivacaine group compared with the control group (p < .01)CONCLUSION:Postoperative pain after septoplasty owing to nasal packing is an important problem, and using levobupivacaine-soaked Merocele as a nasal pack after septoplasty is an effective method for the control of this pain. It is a very easy, effective, and quick method and it improves patient comfort after septoplasty.

Lewenza Shawn Charron-Mazenod Laetitia Cho John J.W. Mechor Brad

AbstractOBJECTIVE:To determine if sinus irrigation bottles from patients with chronic rhinosinusitis (CRS) harbour bacterial contaminants.DESIGN:Patients with symptoms of CRS who showed no mucopurulent infection and had no history of surgery were enrolled in the study. Patients were instructed on the proper use and cleaning of sinus irrigation bottles and were asked to return their rinse bottle during follow-up visits.METHODS:Bacterial contaminants were cultured from the inner surface of the sinus irrigation bottles obtained from patients. Genomic deoxyribonucleic acid (DNA) was isolated from purified colonies and used to polymerase chain reaction (PCR) amplify the 16S ribosomal ribonucleic acid (rRNA) genes. PCR products were sequenced and analyzed in the Human Oral Microbiome Database (HOMD) for genus and species identification based on 16S ribosomal DNA (rDNA) sequence comparisons.MAIN OUTCOME MEASURES:The outcomes included the recovery of bacterial contaminants and their subsequent identification.RESULTS:In total, 142 bacterial isolates were cultured and identified. The organisms included known oral flora bacteria, as well as pathogens of the upper respiratory tract and sinuses. Thirty-two different bacterial species were identified from 11 patients. There was no correlation between the length of bottle use and the degree of contamination.CONCLUSION:This study highlights the risk of bacterial contamination of sinus irrigation bottles and the potential for patient reinoculation.

Kösem Mustafa Bulut Gülay Kaya Zülküf

AbstractOBJECTIVE:Nasal polyps are common, abnormal lesions. Recurrence of the nasal polyposis is prevalent and a severe problem. The aim of this study was to investigate the relationship between Ki-67 immunoreactivity and the risk of recurrence of nasal polyps. Ki-67 staining of polypectomy material was tested as a risk factor for recurrence independent of etiologic factors or treatment modalities.DESIGN:Retrospective study.SETTING:University hospital.MAIN OUTCOME MEASURE:Ki-67 immunoreactivity.METHODS:Pathologic specimens from patients with nonrecurrent and recurrent nasal polyps archived at the Department of Pathology were reviewed, and the most suitable blocks were chosen among the excision materials. Ki-67 antibody staining was investigated immunohistochemically using the avidin-biotin-peroxidase method. The percentages of nuclei immunostained for Ki-67 of at least 1000 epithelial cells in the most intensive staining areas at final magnification (×400) were calculated and defined as the labeling index. The Mann-Whitney U-test was used to compare the Ki-67 labeling index in the nonrecurring and recurring nasal polyp groups.RESULTS:The mean Ki-67 labeling index was 1.4 ± 1.972 (range 1–87 in 1000 epithelial cells) in the nonrecurrent nasal polyp group and 17.8 ± 5.67 (range 82–446 in 1000 epithelial cells) in the recurrent nasal polyp group; the difference between the nonrecurrent and the recurrent group was significant (p < .01).CONCLUSION:The results of this study clearly demonstrate that proliferative activity in the surface epithelial cells of recurring nasal polyps is significantly higher than that in nonrecurring nasal polyps.

Cohen Adam L. Naseri Iman Pinell Ximena Sobol Steven E. Gorwitz Rachel

AbstractOBJECTIVE:Little information is available concerning the treatment of pediatric head and neck infections caused by methicillin-resistant Staphylococcus aureus (MRSA), which is resistant to antimicrobial agents such as cephalosporins. The objective of this investigation is to describe clinical characteristics of pediatric MRSA head and neck infections in the United States and how they are treated.DESIGN:National survey.SETTING:United States.METHODS:Practicing members of the American Academy of Otolaryngology–Head and Neck Surgery were surveyed regarding patients aged < 18 years with MRSA head and neck infections during 2006.MAIN OUTCOME MEASURES:Clinical characteristics and treatment of pediatric MRSA infections.RESULTS:Of 701 surveys sent, 201 were completed (adjusted response rate 30%). Otolaryngologists responding to the survey reported treating a total of 1123 pediatric MRSA head and neck infections in 2006. Forty-seven percent reported treating pediatric patients with MRSA infections in the otologic region, 39% in the oropharyngeal/neck region, and 17% in the sinonasal region. The antimicrobials most frequently used to treat these infections were clindamycin, trimethoprim-sulfamethoxazole, and vancomycin. Cephalosporins and fluoroquinolones were also commonly prescribed.CONCLUSIONS:Otolaryngologists in the United States reported treating a broad range of MRSA head and neck infections in pediatric patients. Although most were treated with appropriate antimicrobials, some were treated with agents not active against MRSA.

Carr Esmond R.M. Robinson Anthony

Brandt Michael G. Franklin Jason H. Moore Corey C.