bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Severe Asian Septal Deformity Using Polydiaxonone Foil
Authors: Lo Stephen
Published: September 2011

Objective

The aim of this study is to determine the functional and aesthetic outcome of reconstruction of severely deformed nasal septum in septorhinoplasty using polydiaxonone (PDS) foil in Asian patients.

Method

A prospective case series of all consecutive patients who underwent septorhinoplasty using PDS foil for complex septal deformity in our institution over a 1‐year period has been reported.

Results

A total of 16 patients were included (13 men, 3 women, mean age 25 years). Eleven had a history of nasal trauma and 2 were revision cases from elsewhere. All required an open approach and underwent extra‐corporeal septoplasty with PDS foil. Tip sculpture was performed in 15, and osteotomies in 10 patients. The septum required spreader graft in only 2 patients. Ten patients presented with preoperative saddle, 8 required augmentation with autologous grafts, and 2 were corrected by septoplasty. Median follow‐up period was 12 months. Satisfaction was achieved in most; one required tip revision. Two cases developed columellar retraction.

Conclusion

The results of the current series in Asians are comparable with previous case series published by the senior author on white patients. In many cases, donor site morbidity secondary to autologous cartilage harvest can be avoided using the technique described here.
Use of GlideScope for NIM EMG Endotracheal Intubation during Recurrent Laryngeal Nerve Monitoring
Authors: Kanotra Sohit P. , Lesser Jonathan , Kuriloff Daniel B.
Published: September 2011

Objective

The proper positioning of the NIM EMG endotracheal tube during recurrent laryngeal nerve monitoring is of paramount importance. In this article we describe our experience with the GlideScope and how it facilitates the accurate placement of the NIM EMG endotracheal tube.

Method

NIM EMG endotracheal intubation was performed in 50 consecutive thyroidectomies using the GlideScope video laryngoscope (Verathon Medical, Bothell, Washington). The correct positioning of the tube was determined by impedance values of less than 5 kX and impedance imbalance of less than 1 kX.

Results

Successful intubation was achieved in all the cases using the GlideScope. The GlideScope helped in the correct placement of the NIM endotracheal tube in the majority of the cases.

Conclusion

Use of the GlideScope is an excellent method to ensure the correct positioning of the NIM tube allowing both the surgeon and the anesthesiologist to participate in the intubation process and confirm correct placement of the tube while also allowing a gentle intubation with improved visibility.
Use of Narrow‐Band Imaging in Detection of Nasopharyngeal Carcinoma
Authors: Thong Jiun Fong , Ranjini Karumathil Sivasankarannair , Loke David , Hwei Mok Paul Kan
Published: September 2011

Objective

Compare narrow‐band images of nasopharyngeal carcinoma (NPC) with normal nasopharyngeal mucosa and adenoidal tissue.

Method

Prospective study on patients attending the Ear, Nose and Throat (ENT) clinic. Nasoendoscopic evaluation using both conventional white light (WLI) and narrow band light (NBI) were performed. Biopsies of the nasopharynx were performed for histological confirmation. Epstein‐Barr virus (EBV) serology was tested in all patients.

Results

Thirty patients were recruited. Of these, 21 patients had no evidence of malignancy on both histological and serological testing. Seven patients had NPC and 1 patient had nasopharyngeal papillary adenocarcinoma. NBI features identified in normal nasopharyngeal mucosa and adenoids, are: 1) regularly arranged follicular pattern, whereby 2) “follicles” are composed of pale centers with dark peripheries. In comparison, NBI appearances of NPC are noted to show 1 or more of the following features: 1) absence of surface patterns, 2) dark brown, irregular wave‐like surface patterns, and/or 3) irregular follicular patterns with dark brown centers and pale peripheries.

Conclusion

With NBI, features on the surface of nasopharyngeal mucosa, adenoidal tissue and NPC are clearly demonstrated and consistently show characteristics as described. NBI may therefore be a useful adjunct in differentiating normal mucosa and tissue from malignancy. Further studies are needed to evaluate its diagnostic accuracy.
Use of Parotid Pressure Bandage for Drainless Parotidectomies: A Modification of an Old Technique
Authors: Chua Dennis Yu Kim , Ho Rachel , Goh Christopher
Published: September 2011

Objective

The use of fibrin glue has been described in parotidectomies to obviate the need for drains. However, the seroma rate postoperatively can be high. We have modified this technique so as to achieve the same successes without the seroma.

Method

A prospective, randomized, case‐control study on 54 patients undergoing superficial parotidectomies. All patients had fibrin glue sprayed on the parotid bed intraoperatively. In group A, a pressure bandage was applied over the parotid area for 12 hours postoperatively. In group B, no pressure bandage was used.

Results

Group A patients stayed an average of 1.1 days postoperatively while Group B patients stayed 1.6 days. The cost savings in terms of hospitalization was $150 for group A patients. The seroma rate detected postoperatively was 10% for Group A patients but 53% in Group B patients. Among all patients with seromas, the average volume of parotid tissue removed was significantly higher at 71 cm3 compared with patients without seroma, whose average volume of parotid tissue removed was 44 cm3.

Conclusion

This paper has shown that it is safer and cheaper to perform parotid surgery with fibrin glue and a parotid bandage. The rate of seroma is related to the volume of parotid tissue removed.
Venous Coupler Dopplers as Microvascular Free Flap Monitors
Authors: Quintanilla‐Dieck Lourdes , Schneider Daniel S. , Wax Mark K.
Published: September 2011

Objective

The use of implantable Dopplers for microvascular free flap monitoring has been widely described as an efficient method for supervising flaps postoperatively. Recently a Doppler incorporated into the venous coupling device has been made available. This allows the use of a single apparatus. We report our experience with this device.

Method

This is a preliminary report of an ongoing prospective study of 19 microvascular free flaps mostly in the head and neck, completed from March 2010 to February 2011, where a venous coupled Doppler was used for postoperative monitoring.

Results

Nineteen free flaps are reported. Ten Dopplers (52.6%) maintained continuous positive signal throughout, 6 (31.6%) became position‐dependent and three (15.8%) became nonfunctional at some point. Two flaps required reoperation for flap and pedicle revision one day after surgery. The first, which developed a hematoma secondary to an arterial bleed from the vascular pedicle, maintained a positive Doppler signal. The second, which presented clinical evidence of impending flap failure, had an intermittent position‐dependent Doppler signal at the time of take back.

Conclusion

This study examines the efficacy of the venous coupled Doppler. Our preliminary results show positional variability in many patients. The venous Doppler coupler appears to be as effective in monitoring flaps postoperatively.
Wound Complication in Post‐chemoradiotherapy Neck Dissection
Authors: Ahsan Farhan , Junor Elizabeth , Ironside Janet , Vernham Guy A. , Ganly Ian , Keh Siew M.
Published: September 2011

Objective

Report the incidence and type of postoperative complications following neck dissection in patients with advanced stage squamous cell cancer of the laryngopharynx treated with chemoradiotherapy (CRT) and to identify factors predictive of these complications.

Method

Design: Retrospective review of case series. Setting: Single institution. Patients: Thirty‐three patients with advanced laryngopharyngeal cancer who underwent postchemoradiation neck dissection between 2003 and 2007 were identified. Intervention: Neck dissection, with or without resection of the primary site, in patients following chemoradiotherapy. Main outcome measure: postoperative complications.

Results

Thirty‐eight neck dissections were carried out in 33 patients (median ± SD age, 59 ± 7.8 years; 85% male). Local wound complications were recorded in 6 (18%) of 33 patients with one mortality from carotid rupture. Complications were seen in 1 (17%) of 6 patients with N1 disease, 5 (23%) of 22 patients with N2, and 0 of 5 patients with N3 neck disease. There was no association between type of neck dissection, medical comorbidities, smoking, time interval between completion of chemoradiotherapy and neck dissection, and rate of complications (P >. 05). There were no recorded systemic complications following salvage surgery.

Conclusion

The incidence of wound complications after neck dissection in patients treated with chemoradiation in our cohort is 18%. This compares favorably to reported literature. Nutritional issues and patients’ co‐morbidities should be addressed to minimize wound complications risk.
Age‐Related Changes of Deglutitive Pharyngeal Clearance Evaluated by Quantitative Measurement
Authors: Umezaki Toshiro , Adachi Kazuo , Komune Shizuo
Published: September 2011

Objective

To know swallowing ability, one of the most important subjects is to evaluate pharyngeal clearance of swallowing. Until today, age‐related change of it has not been well known. We evaluate it in every age group using our newly developed quantitative measuring system in the videofluoroscopic (VF) swallowing study.

Method

The subjects were 65 healthy adults (31 male and 34 female) without dysphagia. All subjects were instructed to swallow 10 mL of 100% barium and the clearance was measured in %. Images of VF were captured, and volumes of contrast media were estimated by calculating thickness as a function of brightness.

Results

Pharyngeal clearance (%) could be measured in all subjects by this system. The mean pharyngeal clearance of them was 93.5%. We divided an age group into under 60 years old (younger group) and 60 years or older (elder group), and we compared the clearance between these 2 groups. The pharyngeal clearance in the younger group was more than 90% (mean: 95.1%), while in the elder group the mean of the pharyngeal clearance was 91.87%. Although these 2 showed a significant difference in pharyngeal clearance (P =. 0021), there was no pathological decrease without aspiration in the elderly.

Conclusion

We successfully delineated the age‐related change of the pharyngeal clearance of swallowing quantitatively in swallowing VF. Even in the elder group, however, the pharyngeal function of them should be better maintained than we expected. In the elderly, merely aging will not but other pathological factors lead to dysphagic condition.
Endoscopic Management of Supraglottic Stenosis
Authors: Vira Darshni , DeConde Adam , Chhetri Dinesh
Published: September 2011

Objective

1) Understand traditional techniques for the management of supraglottic stenosis. 2) Learn minimally invasive endoscopic technique using CO2 laser pharyngoplasty, balloon dilation, and Mitomycin‐C application in the management of supraglottic stenosis.

Method

Case series in a tertiary academic medical center of patients with isolated symptomatic supraglottic stenosis who underwent endoscopic management.

Results

Four patients with symptomatic supraglottic stenosis were initially managed with CO2 laser endoscopic pharyngoplasty, balloon dilation, and topical Mitomycin‐C application under general anesthesia. Subsequent management in 3 patients included office‐based balloon dilations. Voice, swallowing, and airway outcomes are reviewed with minimum twelve month follow‐up. Results were satisfactory in all patients and all were decannulated.

Conclusion

Supraglottic stenosis is a rare entity that has been traditionally managed with supraglottic laryngectomy. However, using minimally invasive endoscopic techniques, long‐term success with minimal morbidity can be achieved and should be considered as a first‐line management option for this condition.
Hands‐Free Speech in Glottic Stenosis Patients
Authors: Young Nwanmegha Osita , Acton Lynn , Lee Esther S.
Published: September 2011

Objective

Glottic stenosis remains a difficult disease entity to treat. Many remain tracheostomy dependent and unable to tolerate traditional speaking valves despite intervention. The inability to communicate while gesturing and using both hands is extremely limiting. We demonstrate a novel way of achieving hands free speech in this population.

Method

Four patients with glottic stenosis who were tracheostomy dependent and unable to tolerate speaking valves were identified. A special tracheostomy tube was designed to fit a hands‐free laryngectomy speaking valve. After being fitted each patient was given at least 2 hours of instruction on how to use the valve.

Results

All patients were able to develop proficiency using the valve. Three of the patients continued using the valve greater then 3 months after developing proficiency. There were no complications.

Conclusion

Hands‐free communication greatly enhances the quality of life of tracheostomy dependent patients. Using a tracheostomy tube specially designed to fit a laryngectomy valve. We demonstrate 4 patients with glottic stenosis able to achieve hands‐free speech.
Multidisciplinary Approach to an Arteriovenous Malformation
Authors: Wang Soo‐Geun , Kim Jeong Tae , Nam Soo Bong , Lee Yoon Se , Lim Yun Sung
Published: September 2011

Objective

Arteriovenous malformations (AVMs) are composed of abnormally connecting feeding arteries and draining veins and lack a regulatory system. Frequent recurrences and unpredictable behavior are their main problems. This study introduces a complicated case of AVM with massive bleeding through the external auditory canal that was treated with a multidisciplinary approach.

Method

We report a complicated case of a huge AVM with a fistula and massive bleeding in the head and neck region to share our treatment experience, together with a literature review.

Results

The patient underwent wide excision with free flap reconstruction after embolization of the bilateral ECA the day before surgery. We used a subtemporal‐infratemporal fossa approach. The dura was exposed after the middle fossa approach and the masticator space before removing the mass. The mass measured 15x15 cm, and the external jugular vein was dilated. The defect was reconstructed using a latissimus dorsi musculocutaneous free flap, measuring 25x15cm in size and 15 mm thick. No flap or wound complication was observed on CT.

Conclusion

The treatment of complicated AVMs in the head and neck region is challenging and a multidisciplinary approach is needed to eradicate the AVM completely without recurrence or complications. This consists of preoperative embolization of vessels, meticulous resection without injuring the feeding vessels, and a reconstruction with well‐vascularized free flap.
Incidence of Recurrent Respiratory Papillomatosis (RRP)
Authors: Omland Turid Brokke , Akre Harriet , Brondbo Kjell , Vårdal Mari
Published: September 2011

Objective

1) Estimate the incidence‐rate of juvenile‐RRP (JoRRP) and adult‐RRP (AoRRP) for each year between 1987 to 2009 in a Norwegian subpopulation. 2) The incidence of HPV‐induced genital‐HPV infections and oropharyngeal cancer in Western countries is increasing. This study was conducted to investigate whether there are similar trends in RRP.

Method

Population‐based epidemiological survey. Two Norwegian subpopulations, with 2.5 million and 1.1 million inhabitants, were investigated for JoRRP and AoRRP respectively. RRP‐patients in all ENT‐departments located in the 2 areas were identified. The estimates are based on data from the Norwegian Census Bureau during the time‐period.

Results

Median age at onset was 34 years (interquartile range, 15) for AoRRP and 4 years (interquartile range, 5) for JoRRP. Concerning age at onset there was neither significant differences between genders, nor significant changes during the time‐period. The overall incidence‐rates in juveniles and adults were 0.17 (95% CI = 0.44‐0.65) and 0.54 (95%CI=0.10‐0.25) per 100 000 respectively. We could show a male preponderance in both groups. (P =. 000 for AoRRP and P =. 038 for JoRRP) There was no significant change of the incidence‐rate during the time period neither for AoRRP nor JoRRP or when stratified for gender in each group.

Conclusion

This study does not support our hypothesis of an increasing incidence neither for JoRRP nor for AoRRP. The estimated incidence‐rates in the Norwegian subpopulations are consistent with former population based epidemiological surveys. Male preponderance in JoRRP was an unexpected finding. Further surveys are warranted.
Management of Dysphonia among General Otolarygologists
Authors: Cohen Seth , Courey Mark , Pitman Michael , Noordzij Pieter
Published: September 2011

Objective

Investigate common treatment approaches of general otolaryngologists for adult patients with dysphonia, particularly for patients without obvious laryngeal anatomic abnormalities.

Method

One thousand randomly chosen AAOHNS general otolaryngologists were mailed a survey. The response rate was 27.8%. Mean years in practice were 19.5 years.

Results

The most common treatments for adult dysphonic patients were anti‐reflux treatment, voice therapy, and allergy treatment. For patients with mobile vocal folds without lesions on laryngoscopy, 52% refer to speech‐language pathologists, 57.9% obtain stroboscopy, and 58.6% start proton pump inhibitors (PPI). Muscle tension dysphonia, vocal fold nodules, and dysphonia of uncertain etiology were the most common reasons for voice therapy referral. Response to once daily PPI, laryngeal signs, and throat symptoms were the most common determinants for LPR. When patients failed initial treatment, 46.9% obtain stroboscopy, 37.4% refer for voice therapy, and 33.3% extend or increase duration of PPI treatment.

Conclusion

Varied treatment approaches to adult dysphonic patients were identified. How practice patterns vary from best practice guidelines, impact patient outcome, and influence health care costs needs examination.
Mechanical Modulation of Cuff Pressure Reduces Airway Injury
Authors: Osborn Alexander , Luginbuehl Igor , Fisher Joe , Forte Vito
Published: September 2011

Objective

Test a valve‐based mechanical means of modulating endotracheal tube cuff pressure and its efficacy in reducing airway injury.

Method

We developed a mechanical valve‐based device that modulates endotracheal tube cuff pressure with the respiratory cycle. We tested this device in a previously validated porcine model of accelerated airway injury. Laryngeal specimens from animals intubated with a modulated cuff pressure were compared to those intubated with a constant cuff pressure.

Results

We have demonstrated that the valve‐based device adequately maintains ventilation. Furthermore, there was a significant reduction in the amount of histologically evident injury to the subglottic and tracheal areas of the airway in those animals that were maintained with a modulated cuff pressure. There was no difference between the 2 animal groups in the degree of supraglottic or glottic injury.

Conclusion

This valve‐based system is inexpensive, reliable, and effective in reducing airway injury. Validation of this device in the clinical setting would allow its widespread application and potentially result in a significant reduction in airway injury from prolonged intubation.
Proposal for Improved Efficiency through Taped Patient Encounter
Authors: McRackan Theodore R. , Labadie Robert F.
Published: September 2011

Objective

An extensive amount of time goes into each patient encounter that is unrelated to providing clinical care. This study introduces a new concept that integrates billing/coding, transcription, and patient education through digitally recorded patient encounters.

Method

In the taped clinical encounter, the history of present illness, past medical history, physical examination, and assessment and plan are recorded. Between each section the clinician provides a summary of the pertinent data collected. The video is then reviewed by a coding expert for billing purposes.

Results

In carrying out the above in a standardized patient, we successfully eliminated all paperwork and dictation that would be done after leaving a patient’s examination room. A typed transcription of the pertinent patient summary dictated to the camera was entered into the patient’s electronic medical record. A digital record of the encounter was also made available through the electronic medical record that the patient could access from home. This allows the patient to review the diagnosis and treatment plan to improve compliance. Both records were also available to the referring physician to review.

Conclusion

Through the digital recording of patient encounters, we hope to improve clinical efficiency, coding accuracy, patient compliance, and referring physician gratification.
Nerve Fibers in Laryngeal Muscle Following Injury on Nerve
Authors: Toya Yutaka , Yumoto Eiji , Minoda Ryosei , Kumai Yoshihiko
Published: September 2011

Objective

Compare the modulation of nerve fibers, 1) between recurrent laryngeal nerve (RLN) and vagus nerve (VN) in the thryroarytenoid (TA) muscle, 2) between RLN in TA and peroneal nerve (PN) in tibialis anterior (TbA) muscle following nerve section and immediate anastomosis using rat model.

Method

Rats were sacrificed at 5 occasions after nerve section followed by anastomosis. Axons, myelin sheaths, Schwann cells, nerve terminals, and acetylcholine receptors in TA and TbA were quantified by immunohistochemistry. Data were expressed as the ratio between treated and untreated sides (T/U ratio).

Results

Eighteen weeks posttreatment, the mean T/U ratios for axon expression were RLN: 68.5%, VN: 0.0% and PN: 99.2%; the ratios for myelin sheath were RLN: 0.0%, VN: 0.0%, PN: 97.6%; the ratios for Schwann cells were RLN: 53.7%, VN: 0.0%, and PN: 93.6%; the ratios for nerve terminals were RLN: 61.0%, VN: 0.0%, and PN:96.4%; and the ratios for acetylcholine receptors were almost 100% for RLN and PN and 67.2% for VN. For all measurements there was a significant difference between RLN and PN at the 18 weeks time point (P <. 001).

Conclusion

These results show that, at 18 weeks, regeneration did not occur in VN. On the other hand, regeneration occurred in both RLN and PN, moreover, nerve fibers were more matured in PN compared to RLN.
Recalcitrant Airway Stenosis in Patients with Abnormal Scars
Authors: Pacheco Paulette , Garcia Evamariely , Gonzalez‐Aquino Carlos
Published: September 2011

Objective

1) Identify factors that lead to failures in laryngotracheal reconstruction. 2) Substantiate the clinical suspicion that patients with aberrant wound healing are more likely to fail initial reconstruction surgery, requiring multiple procedures. 3) Consider this population for research in the genetics of subglottic and tracheal stenosis.

Method

A retrospective chart review of patients who failed initial laryngotracheal reconstruction surgery and required additional procedures. The main outcome measure was decannulation. We evaluated demographic data, cause of stenosis, Cotton‐Myer grade, surgical techniques, medications employed, and whether patients presented evidence of aberrant wound healing in other anatomic sites.

Results

Six records were identified. Five of these (83%) demonstrated hypertrophic scarring on physical examination. The cause of stenosis in every patient was mechanical ventilation ranging from 5 to 20 days. All patients presented with Cotton grades 3 or 4. Although surgical technique did not vary among patients, all underwent a minimum of three interventions over a 2‐year period, despite the regular use of steroids and anti‐reflux medications. Mitomycin C was used in only 1 patient and she is currently tolerating capping. Two patients have been deccanulated, but continue to exhibit dyspnea on exertion. Three are still tracheotomy dependant.

Conclusion

We have observed a high incidence of scarring in patients failing initial laryngotracheal reconstruction. Although multiple causes for failure have been identified in the literature, this correlation has not been reviewed. Our results suggest there may be a genetic predisposition to develop airway stenosis in this group of patients.
Recurrent Laryngeal Papillomatosis, Juvenile and Adult: 1990‐2010
Authors: Zamalloa Shirley Paola Gutierrez , Lorenzo Ana Isabel , Hidalgo Camelo Santidrián
Published: September 2011

Objective

Laryngeal papillomatosis is a rare disease, benign, recurrent, with potential for malignancy according to viral type and aggravating factors. Its high recurrence raises different therapeutic modalities. Here we review our experience in 20 years on behavior and type of performed treatment.

Method

A descriptive study of a cohort of patients of the University Complex Hospital to Vigo (CHUVI) from January 1990 to December 2010 with papilloma and recurrent respiratory papillomatosis.

Results

We found 37 cases, 4.35 incidence rate per million population per year, average age 49 years, 81.1% males, 71% history of smoking, 51.4% had symptoms years before the first consultation, 33.3% settled on right vocal cord, 64.9% treated with CO2 laser, 51.5% histology compatible with human papilloma virus, 6 cases became viral typing, 4 positive and 100% HPV type 11. A total of 47.2% relapsed, the average number of interventions was 5 times per patient, 18.9% malignant and none of them had HPV study, 13.8% laryngectomy was performed, until the time of study 43.3% cured and 10% in remission.

Conclusion

In our area, laryngeal papillomatosis is a rare disease, more common in middle‐aged men with malignant potential and frequent relapses. It is important to study HPV monitored closely and cessation of toxic habits after surgery. It is necessary to seek alternative therapies.
Relationship between Nasal Valve Changes and Nasalance of the Voice
Authors: Gerek Mustafa , Durmaz Abdullah , Tosun Fuat , Birkent Hakan , Aydin Umit , Hidir Yosuf
Published: September 2011

Objective

Investigate the effect of nasal valve changes on nasalance of the voice by using an external nasal dilator strip that widens the nasal valve area.

Method

Healthy volunteers who had normal nasal and laryngeal findings were enrolled into the study. All volunteers received acoustic rhinometry and nasometry before and while wearing a commercially available external nasal dilator strip. The data with and without nasal strip were compared.

Results

Twenty‐five subjects were enrolled into the study. After application of the nasal strips, statistically significant increases were observed in the minimal cross‐sectional area of the nasal valve. However, there were no significant changes in nasalance measurements.

Conclusion

Despite increasing the nasal valve area, application of nasal strips did not cause a significant change in nasalance scores, showing no relationship between the nasal valve changes and nasalance of the voice.
Rosai‐Dorfman Disease with Isolated Laryngeal Involvement
Authors: Kaden Andreas , Illing Elisa , Porter Paul , Halum Stacey L.
Published: September 2011

Objective

Rosai‐Dorfman (RD) disease is also known as sinus histiocytosis with massive lymphadenopathy (SHML) because of its characteristic lymph node involvement. It is exceedingly rare for RD to present with isolated, recurring laryngeal involvement without lymphadenopathy. This case presentation highlights this rare scenario, and difficulty in managing recidivistic laryngeal involvement.

Method

Case presentation with review of literature.

Results

A 45‐year‐old woman presented to our laryngology clinic with dysphonia from a recurring right hemilaryngeal mass. Prior removal and analysis showed inflammatory mass and work‐up for sarcoidosis and Wegner was negative. Videostroboscopy showed large right submucosal fullness of right true vocal fold and this was confirmed on imaging. She underwent removal of the mass and pathologic diagnosis remained inconclusive. After 6 months the mass recurred and repeat pathologic analysis was consistent with RD disease. After multiple recurrences requiring emergent intervention and limited response to steroids, radiation therapy was initiated.

Conclusion

Rosai‐Dorfman disease is a rare disease of massive lymphadenopathy and histiocytosis. The presentation with exclusive laryngeal involvement is rare, and due to extensive surrounding fibrosis and inflammation, histopathologic diagnosis was difficult. This case demonstrates that radiation therapy should be considered if surgical excisions and steroids are inadequate.
Spasmodic Dysphonia Translocated via Reinnervated Ansa Cervicalis
Authors: DeConde Adam , Armin Bob B. , Berke Gerald S. , Long Jennifer L.
Published: September 2011

Objective

Illustrate the first reported case of recurrent adductor spasmodic dysphonia (ADSD) after bilateral selective laryngeal adductor denervation‐reinnervation (SLAD‐R) surgery presenting with dystonia of the strap muscles and adductors of the larynx.

Method

A 40‐year‐old man presented with ADSD. The patient underwent a bilateral SLAD‐R surgery 10 years ago after botulinum toxin failure. The laryngeal dystonia was quiescent until 2 years ago when the patient noted worsening tension in his voice temporally associated with muscle spasm of his anterior neck.

Results

The patient elected to undergo re‐exploration of his neck with lysis of his ansa cervicalis reinnervation. The operation revealed bilaterally intact neurorrhaphies between the superior root of the ansa cervicalis and the distal recurrent laryngeal nerves. Electrical stimulation of the superior roots of the ansa cervicalis produced laryngeal adductor activity as evidenced by an electromyography nerve monitor and by palpation of the arytenoids cartilage. The neurorrhaphies were sectioned and postoperatively the patient’s dystonias immediately resolved.

Conclusion

We present a case of demonstrated functional activity of nerves used for reinnervation in SLAD‐R surgery for spasmodic dysphonia. Unfortunately in this case, the disease recurred through aberrant activity mediated via the translocated ansa cervicalis nerves.
Surgical Treatment of Laryngeal Papillomatosis Using NBI
Authors: Imaizumi Mitsuyoshi , Tani Akiko , Omori Koichi , Suzuki Teruhisa , Okano Wataru , Tada Yasuhiro
Published: September 2011

Objective

Multiple laryngeal papillomatosis has a high rate of recurrence after surgery. Narrowband imaging (NBI) is a novel optical enhancement technology used for the diagnosis. This is the first report to date to indicate the availability of the combination of laryngomicro surgery and videoendoscopic surgery for laryngeal papillomatosis using NBI technology.

Method

The patients were 34‐year‐old and 30‐year‐old men. Both cases underwent surgery in another hospital. However, because of recurrence, they were subsequently referred to our department for further evaluation. Examination in our outpatient clinic revealed papilloma‐like mucosal changes, and recurrent multiple laryngeal papillomatosis was diagnosed in both cases.

Results

In laryngomicroscopic surgical findings, the presence of papillomas was confirmed by NBI, and the papillomas were removed using an XPS Micro Debrider and a CO2 laser. Using the NBI system, the border between the normal mucosa and the papillomas could be clearly identified, allowing precise resection. Two months later, CO2 laser resection using a laryngeal flexible endoscope under topical anesthesia was undertaken in an outpatient setting for recurring or remaining papilloma lesions. Further treatment on the lesions has been carried out several times to date using NBI. The lesions have now been eradicated without further recurrence.

Conclusion

Herein we reported 2 cases of multiple laryngeal papillomatosis that were treated by tumor resection using NBI. Clearer identification of the tumor border was obtained by this technique, thus allowing minimally invasive resection. This paper demonstrates the applicability of the NBI system to the identification and resection of laryngeal papillomatosis.
The Use of Lesion Localization Needles in Tracheal Resection
Authors: Ferguson Louisa , Sandhu Guri , Sarju Vasani
Published: September 2011

Objective

We propose the use of a localization needle (X‐Reidy Lesion Localization needle ) to mark the position of tracheal lesions under direct vision. We believe this technique allows an accurate way of localizing difficult tracheal lesions.

Method

X‐Reidy Localization single needle is generally used to localize non‐palpable breast lesions prior to surgical excision. We place the wire through the skin and into the tracheal lumen using suspension laryngoscopy and supraglottic jet ventilation technique at the beginning of the procedure.

Results

Lesions obstructing the trachea can often be difficult to diagnose and can masquerade as asthma or chronic bronchitis. When the lesion is found to be malignant or definitive surgery is appropriate for benign lesions we perform tracheal resection and defining the portion of the trachea to excise is imperative. This method allows us to dissect down directly onto the portion of the trachea from which the lesion arose, which is not always clinically obvious from the external approach.

Conclusion

Tumors of the upper airway are most often malignant, although in themselves are rare, accounting for less than 1% of all malignancies. Among the inflammatory strictures, postintubation injuries remain common in developed countries. This method of localizing tracheal lesions, we believe is of benefit to the surgeon.
Transoral Endoscopic Coblation for Early Glottic Carcinoma
Authors: Zhang Qingfeng , Liu Delong , Timms Michael S.
Published: September 2011

Objective

Investigate a new application for radiofrequency ablation in head and neck surgery, for early glottic carcinoma, the short‐term efficacy of the surgery was observed.

Method

Three patients with early glottic carcinoma (T1 2, Tis 1) were successfully treated using transoral endoscopic coblation (TEC). The technique is described in detail, highlighting the main benefits of this approach as compared with existing techniques.

Results

Adequate removal of disease was achieved without complications and no recurrence was observed in the study period.

Conclusion

Short‐term observation exceeding 2 years suggests that the coblation appears to be an attractive evolving, reliable and safe modality for early glottic carcinoma, although current probe size is not enough small. This should be regarded as a pilot study.
Treatment of Epiglottic Cyst by Radiofrequency Snare
Authors: Zhou Annie
Published: September 2011

Objective

Epiglottic cysts are common in clinic and are excised by operation. Our department adopts domestic radiofrequency therapy apparatus which is low in cost. At the same time, the radiofrequency ablation of the radiofrequency treatment group has the function of stopping bleeding and reducing recurrence.

Method

All 40 patients were divided into 2 groups according to random numerical expressions. The epiglottic cyst of the 20 patients in the treatment group was excised by radiofrequency snare and that of patients in the control group was excised by routine operation.

Results

The postoperative pathological diagnosis of the 40 patients was in accordance with epiglottic cyst. The curative rate in radiofrequency treatment group is 100% and in routine operation group is 95%.

Conclusion

With our operation, the thrombus formation and the vascular occlusion have good anastalsis. The snare can be freely operated under the under self‐retaining laryngoscope to ablate masses, which maximally protects the surrounding normal tissues.
Ultrasonic Aspirator‐Assisted Laryngeal Framework Surgery
Authors: Daniero James , Spiegel Joseph , Boon Maurits
Published: September 2011

Objective

(1) Demonstrate the utility of the ultrasonic surgical aspirator in minimizing the risk and simplifying laryngeal framework surgery. (2) Determine the benefits using of this technique in the setting of resident education.

Method

Case series using the SONOPET ultrasonic surgical aspirator (MIWATEC Co., Ltd.) to enable precise dissection of laryngeal cartilage without thermal or mechanical injury to the surrounding soft tissue or mucosa. We describe the first application of this technology in the in vivo larynx for type I thyroplasty and laryngofissure approaches.

Results

Laryngeal framework surgery using current techniques have the limitations of difficulty incising calcified cartilage, mechanical chatter, thermal injury, and soft tissue damage. The ultrasonic surgical aspirator was used in four medialization thyroplasty procedures and two laryngofissure approaches for open laryngoplasty without intraoperative or postoperative complications. No infections or inadvertent soft tissue damage were observed. There were no complications of implant placement or with early healing. Finally, a very slight learning curve exists for its use in resident performed procedures and time to perform cutting tasks was faster than standard techniques.

Conclusion

The ultrasonic surgical system may be used as an alternative to standard surgical technique, surgical drill, or oscillating saw for laryngeal framework surgery. Limited learning curve exists and our results indicate that the device can be used safely and in a reasonable amount of time.
Vocal Problems: Teachers’ Attitudes and Healthseeking Behavior
Authors: Charn Tze Choong , Mok Paul Kan‐Hwei
Published: September 2011

Objective

Teachers are at high risk for vocal disorders due to their intrinsic occupational requirements. Numerous studies have reported on the prevalence and risk factors. Less is known about teachers’ ideas and attitudes. We aimed to explore teachers’: 1) attitudes towards voice problems and 2) health seeking behavior.

Method

A cross‐sectional study was conducted by cluster sampling method across 6 primary schools in Singapore in 2008. 214 full time teachers were recruited. Self‐administered questionnaires were answered during each school’s teachers meeting after informed consent.

Results

A total of 89.9% of teachers agree that losing one’s voice is an occupational hazard. A total of 92.8% agree that their profession depends on the health of their voices. A total of 79.6% think that attending voice workshops will help to prevent voice problems. A total of 65.4% have had taken medical leave for voice problems in the past 12 months, of which 9.3% of them had taken 6 days or more of leave. A total of 81.7% consulted a general practitioner, 3.6% an otolaryngologist, 0% a speech therapist, and 14.8% others.

Conclusion

The surveyed teachers have very similar demographics compared with the national teaching population and are hence broadly representative. The results showed that teachers do value their voices and deem them essential for carrying out their professional duties. Productivity losses to the education system and emotional losses are real entities.
Otoplasty: An Alternative Approach
Authors: Guilemany José M. , Gomez‐Vieira Álvaro , Montero Cristobal Langdon
Published: September 2011

Objective

An alternative approach to perform otoplasty by combining cartilage excision, Mustarde technique and modified Furnas technique.

Method

Postauricular skin excision including subcutaneous tissue and postauricularis muscle was created to expose the deep surface of auricular cartilage. The anterior surface of the cymba and cavum conchae is marked. Posterior cartilage island excision is made in the cymba and cavum conchae leaving at least 5 mm of the helix root.

Results

The antihelix surgical procedure consists of a classical Mustarde suturing to recreate the fold of the new antihelix. Finally, stabilization of the conchal cartilage is achieved by 2 nonabsorbable sutures (cymba, cavum conchae) to the mastoid fascia with superior and inferior vectors to improve the prominence of the helix to the scalp. Our preference for skin closure is polypropylene 5‐0 suture.

Conclusion

This combined technique is safe and easy to perform, with a good cosmetic outcome. The advantages are: 1) Avoid leaving a wrinkled appearance in the anterior conchal skin, and 2) Accomplish a better conchomastoid complex stabilization.
A Prospective Study of an iPhone‐Assisted Particle Repositioning Maneuver for BPPV
Authors: Organ Brock , Bromwich Matthew A.
Published: September 2011

Objective

Determine if the use of an iPhone application (DizzyFIX ‐ Clearwater Clinical Ltd) designed to assist in the performance of the particle repositioning maneuver (PRM) for benign paroxysmal positional vertigo (BPPV) had a significant impact on medical students’ performance.

Method

Study design: Randomized, single‐blinded, prospective trial. Setting: Tertiary Care Hospital. Participants: Medical students. Intervention(s): Forty‐one participants performed the PRM and were scored by a blinded observer. Twenty‐one participants used the application while the remainder used a sham. Main outcome measure(s): PRM score, graded on an 11‐point scale, and total time.

Results

Participants randomized to the iPhone application group scored higher on their observed performance of the PRM than the placebo group (P <. 0001) with a mean difference of 4.98 points. Participants randomized to the placebo group consistently performed the maneuver faster (P <. 0001) than those who had a functional iPhone application. The average placebo participant performed the maneuver in only 79.9 seconds while participants in the test group averaged 245.8 seconds. In summary, initial testing demonstrated that participants using the DizzyFix iPhone application conducted the PRM more accurately and slowly than the participants using a placebo.

Conclusion

The use of this new iPhone application enables senior medical students to perform a more correct PRM than without assistance. This application represents a significant improvement from written instructions and standard medical school training.
Accuracy of Tinnitus Matching Using a Web‐Based Protocol
Authors: Ziai Kasra , Djalilian Hamid R. , McGuire John , Brunworth Joseph D.
Published: September 2011

Objective

1) Learn whether a web‐based protocol can be used to match tonal tinnitus. 2) Compare the accuracy of a web‐based protocol with tinnitus matching using an audiometer.

Method

Twenty subjects had tinnitus frequency matching using an audiometer in an anechoic chamber using a standard protocol. The subjects then matched their tinnitus at a desktop computer in an examination room using a web‐based protocol with a multiple choice and a slider. Octave challenge testing was performed.

Results

The age ranged between 30 and 77 years (median age, 53.5 years). Median tinnitus frequency was 6000 Hz (range, 2000‐12000 Hz) using the audiometer and multiple choice self‐directed protocol. Using the slider, the median frequency was 5925 Hz (range, 1850‐16000 Hz). The patients with tinnitus frequency of over 12000 Hz experienced a higher level of satisfaction with their tinnitus match when using the computer‐based slider system. Five patients (25%) experienced octave confusion (matched to a frequency one octave below or above) when performing self‐directed multiple choice tinnitus matching. These patients accurately matched their tinnitus frequency after the octave challenge step.

Conclusion

A web‐based protocol for tinnitus frequency matching is as accurate as a standard protocol. Patients with very high frequency tinnitus preferred a web‐based slider. Patients may inaccurately identify their tinnitus frequency as one octave above or below. An octave challenge test is necessary for a patient‐directed tinnitus frequency matching.
Age and Time Interval Differences in Recurrent and Residual Cholesteatoma Rates for Canal Wall Up Tympanomastoidectomy
Authors: Herman Bjorn S. , Anderson Joshua , Angeli Simon I.
Published: September 2011

Objective

1) Evaluate whether residual or recurrent cholesteatoma found during second‐look tympanomastoidectomies correlates with age. 2) To evaluate whether there is a difference in residual or recurrent cholesteatoma found during second‐look tympanomastoidectomies done before and after 9 months since the initial procedure.

Method

This is a longitudinal study of second‐look tympanomastoidectomies performed at a tertiary‐care center between 2002 and 2010. Demographic and clinical data was collected prospectively. Statistical analyses were performed to determine whether patient age and time interval between initial and second look procedures correlated with residual or recurrent cholesteatoma.

Results

Seventy‐two patients qualified for the study. Residual cholesteatoma was more frequent in children (<15 years) than adults (P =. 026, Fisher exact test). There was a tendency for recurrent cholesteatoma to occur more frequently in adults than in children. Recurrences tended to occur more frequently in cases with larger canal wall defects. The time interval between the primary and revision surgery did not influence the rate of residual or recurrent cholesteatoma.

Conclusion

Younger patients have a higher risk of residual cholesteatoma, possibly secondary to more technically challenging anatomy and surgeon preference to maintain an intact canal wall. Time between primary and revision surgery could be abbreviated or prolonged, since this interval did not influence residual and recurrent cholesteatoma rates.
Prevention of Head and Neck Keloid with 5% Imiquimod Cream
Authors: Karimi Kian , Jadidian Armon , Adelson Robert
Published: September 2011

Objective

Retrospectively review the charts of patients from the University of Florida Facial Plastic Surgery Clinic over the past 4 years in order to evaluate the efficacy of keloid prevention after surgery with application of 5% imiquimod cream topically to excised areas.

Method

Retrospective chart review. Classification of keloid subsite in the head and neck, and recurrence rates as documented in electronic encounters will be analyzed. Patients that have not followed up for greater than 3 months will receive a phone call for follow up.

Results

The main result measured will be recurrence rates of head and neck keloid that have undergone surgical excision of these lesions followed by application of 5% imiquimod cream for 6 weeks. This will be obtained from retrospective review of clinic charts from the University of Florida patient database in addition to phone calls to previously treated patients that have not been seen in clinic for greater than 3 months.

Conclusion

Pending results and analysis, we hypothesize that application of 5% imiquimod cream following surgical excision of head and neck keloid leads to lower recurrence rates than what is quoted in the literature.