Appendix Risks and Complications of Tympanoplasty
Ear infection, with drainage, swelling, and pain, may persist after surgery or, on rare occasions, may develop after surgery due to poor healing of the ear tissue. Were this to be the case, additional surgery might be necessary to control the infection. Committee on Conservation of Hearing of the American Academy of Ophthalmology and Otolaryngology Standard Classification for Surgery of Chronic Ear Infection I. Of the Technical Procedures in Surgery for Chronic Ear Infection II. Of the Gross...
Management of Inverting Papilloma
Intranasal approaches have been fraught with recurrences because these tumors are usually bulky, creating a difficult exposure. However, otolaryngologists have been gradually extending the indications for minimally invasive intranasal operations, including endoscopic techniques. Does endoscopic sinus surgery have the potential to lower the high recurrence rate associated with the intranasal approach to that of external techniques, on a consistent basis The only reason to change management...
TABLE 302 Glogau Classification
Mild pigmentary changes No keratoses Minimal wrinkles Patient age 20s or 30s Minimal or no makeup Minimal acne scarring Early to moderate photoaging Early senile lentigines visible Keratoses palpable but not visible Parallel smile lines beginning to appear Patient age late 30s or 40s Some foundation usually worn Mild acne scarring Obvious dyschromia, telangiectasias Visible keratoses Wrinkles present even when not moving Patient age 50s or older Acne scarring present makeup does not cover...
Factors Involved in Treatment Algorithm for Chronic Otitis Media
The initial evaluation of patients with chronic otitis media should include a thorough otologic and general medical history. The otologic history must include careful documentation of symptoms and previous treatment, both medical and surgical. The general medical history should include documentation of potential predisposing factors including upper respiratory allergy, smoking, diabetes mellitus, and possible immunologic compromise. Examination should include a thorough otologic and complete...
Info Cpx
Assessment and Management of the Unknown Primary with Neck Disease Suspicious areas of mucosa e.g., leukoplakia, erythroplasia, or mucosal irregularities seen on prior physical examination or on imaging studies should be biopsied. If no such lesions are seen, random biopsies should be performed on mucosal sites with the known highest probability of harboring a tumor i.e., nasopharynx, tonsil, tongue base, pyriform sinus. The routine use of CT or MRI for the purpose of attempting to identify a...
Bells Palsy
The clinical course of patients with Bell's palsy varies from rapid early complete recovery to a more debilitating course of permanent disfiguring facial nerve dysfunction. Fortunately, most Bell's palsies recover completely and spontaneously, with 85 of patients with Bell's palsies having a full or near full recovery. Those patients who have a complete paralysis persisting for 8 weeks are likely to develop sequelae. All patients, however, regain some function within 6 months and, if no motion...
Tinnitus And Aural Fullness
Tinnitus and aural fullness are vague symptoms that should not be used alone to make the diagnosis of perilymph fistula. In perilymph fistula tinnitus usually occurs with hearing loss or may increase during instances of increased intracranial pressure without any further hearing loss occurring. A sense of fullness in the involved ear can often be elicited from patients as beginning after the initial precipitating event. Aural fullness without other symptoms such as hearing loss or vertigo are...
Background Mmt
Controversy in the management of otosclerosis began in 1876 with the first attempt at surgery for otosclerosis with total stapedectomy by Kessel. Unsuccessful largely due to a lack of sterile technique and antibiotics, otosclerosis surgery was abandoned until 1923, when Holmgren performed a three-stage lateral semicircular canal fenestration, a technique later improved by Lempert. The next era of controversy paralleled advances in surgical technique. Very controversial at the time, the first...
Evolution of Radiosurgery
Lars Leksell coined the term stereotactic radiosurgery in 1951. He developed the technique for delivery of a single high dose of precisely focused radiation to achieve closed skull destruction of a small intracranial target. Acoustic tumor stereotactic radiosurgery using the Gamma knife unit was first performed by Leksell in 1969.21 In a review of his 20 years' experience with treatment of acoustic neuromas by radiosurgery, Nor n et al.15 reported that more than 90 of patients had tumor growth...
Conclusion Btl
A stepwise approach, graded or balanced in reference to the severity, risks, and costs of the otorrhea problem, is advised. Typically, the initial management includes topical and or oral medications directed at likely pathogens. In recalcitrant cases, antimicrobial therapy guided by Gram stain, culture, and sensitivity data acquired from a representative specimen obtained through the lumen of the tympanostomy tube is helpful. If otorrhea persists for several weeks despite these usual treatment...
Background Fot
Aufricht4 defined the SMAS layer in his article reviewing 15 years of SMAS surgery as the area overlying the parotid and underlying the skin of the face and cheek. This sheet, present in the embryo, is made of fibrous tissue and of some muscular fibers superiorly, it is related to the obicularis and frontal muscles and inferiorly by the platysma. Lying between the muscles of facial expression and the skin, it arches over the zygoma and stretches from the tragus to the nasolabial fold, fanning...
COMPLICATIONS OF PLFs
Curiously, PLF-related complications are rarely, if ever, discussed in the literature. In addition to the comorbid conditions discussed above, there are three significant complications of PLFs Hearing loss, vestibular function loss, and meningitis. Hearing loss is a complication of a PLF and should never be regarded as either a primary consequence or inevitable result of PLF. Hearing loss complicating PLFs is a true otologic emergency. Sensorineural hearing loss indicates hair cell damage and...
Examples of Computed Tomography Staging Systems
Staging system proposed by Kennedy 0 Anatomic abnormalities, all unilateral sinus disease, bilateral disease limited to ethmoidal sinuses Bilateral ethmoidal disease with involvement of one dependent sinus Bilateral ethmoidal disease with involvement of two or more dependent sinuses on each side Staging system proposed by Gliklich and Metson Harvard System 4 0 Normal lt 2 cm mucosal thickening on any sinus wall 1 All unilateral disease or anatomic abnormality II Bilateral disease limited to...
Management of the Draining Pressure Equalization Tube
Probably less than 5 of all patients with chronic draining PE tubes, have underlying localized mucosal or temporal bone disease, or upper respiratory immunologic, allergic, or bacterial disease that perpetuates tube drainage. Dry or serous effusions are rarely associated with PTOs, whereas mucoid or mucopurulent effusions and or middle ear mucosal disease is statistically correlated with PTO. An enormous literature has been dedicated to surgical PTO prophylaxis. Although contradictory,...
Laser Resurfacing
Although laser physics was first described by Albert Einstein in 1917, laser technology did not appear until the 1960s. Only in recent times have the CO2 and erbium lasers found their way into the cosmetic surgeon's armamentarium as skin resurfacing tools. These high-energy lasers have revolutionized the treatment of photoaged skin. In contrast to other forms of skin resurfacing, laser resurfacing has captured the attention of many people worldwide. When referring to laser resurfacing, the...
Management of Synkinesis and Hyperkinesis
Injection of botulinum toxin can be quite helpful for patients who develop hyperkinesis following reinnervation e.g., after XII to VII cross-innervation . It may also be helpful for patients who have severe synkinesis that results in excessive facial twitches. The toxin is injected into the orbicularis oculi muscle for eyelid spasms and into the zygomaticus major muscle for midfacial spasms. EMG may be helpful in localizing the muscle for injection. An initial dose of 5 to 10 U can be injected...
Conclusion Amy
Salivary fistulae are a troubling complication in surgery of the upper aerodigestive tract. Their prevention is based on sound surgical technique and decision making. Attention to mucosal closure without tension and great vessel protection are the most important factors. If a fistula occurs, the initial management is conservative and supportive unless the carotid artery or jugular vein is exposed. Nutrition should be maximized and hypothyroidism and diabetes corrected. Saliva should be diverted...
Phenol Peels
Phenol represents the most common deep chemical peeling agent. It leads to dramatic results by producing a controlled chemical burn to the level of the upper reticular dermis. As healing occurs, new stratified collagen is laid down, resulting in younger-appearing skin. Phenol is an extremely effective agent for reversing facial wrinkling and irregular pigmentary changes related to sun exposure and the natural aging process. The most commonly used phenol preparation is the BakerGordon formula,...
Rectus Abdominis Flap
The rectus abdominis muscle arises from the pubic crest and symphysis pubis and inserts into the fifth, sixth, and seventh ribs. The muscle has a dual blood supply from the superior and inferior epigastric arteries the latter is most commonly used for free tissue transfer. The motor innervation to the muscle is from multiple segmental intercostal nerves. The flap can be harvested with or without a skin paddle, depending on the nature of the defect. After making the proper skin incisions, the...
Introduction to the Opportunistic Biplane Facelift
The biplane facelift described in this chapter is based on principles that increase aesthetics and longevity with limited morbidity. Facial aging is most pronounced from changes occurring in the deeper musculofascial plane that result in ptosis of the malar fat pad, jowl region, nasolabial folds, and neck. Precise elevation and rotation of this plane is accomplished using this biplane facelift technique. We call the operation opportunistic, because there is no set anatomic limit to the...
Perilymph Fistulae
In about 50 of patients with bilateral PLFs, the PLFs will close in the second ear during the period of bed rest after surgery on the first ear. In the event that both ears require tympanotomy, we recommend a minimum 3-month interval between operations. A sensitive and specific marker of perilymph would greatly facilitate identification of PLF. Attempts to find a marker using colorimetric markers such as fluorescein have not been successful. Chemical markers specific for CSF b-2-transferrin...
Neck Dissection
Vessel thrombosis rates for head and neck free flaps are lower than for any other anatomic site due to in part to the abundance of accessible recipient vessels.2 However, potential recipient vessels, such as the external and internal jugular veins and their tributaries, may be sacrificed in an extensive neck dissection or may be damaged due to radiation or inflammatory changes. In these cases, local veins of small caliber can be used, but the risk of thrombosis is increased. We prefer to use...
Surgery
There can be little doubt that vestibular surgery has been overdone. Nevertheless, surgery has a role in Meniere's disease. There are two main types of operation for Meniere's disease destructive and nondestructive. The destruction is done to hearing. There are also some procedures that may or may not be destructive. There are two types of nondestructive surgery for Meniere's disease 1. Repair of presumed perilymphatic fistula PLF Some investigators believe that the symptoms of Meniere's...
Characteristics of Intracanalicular Acoustic Neuromas
An intracanalicular acoustic neuroma is lt 1 cm in length and appears rounded in the early stages. Upon filling the internal auditory canal IAC , it assumes an oblong shape. At diagnosis, three variations are encountered, depending on the extent of involvement of the IAC 1 medial IAC location near the porus acousticus, 2 lateral IAC involvement near the fundus, and 3 involvement of the entire IAC. True intracanalicular tumors involve only the IAC, although many tumors can be considered...
Suggested Readings 1
Rosen S. Palpation of stapes for fixation preliminary procedure Schuknecht HF. Stapedectomy. Boston Little, Brown, and Co. to determine fenestration suitability in otosclerosis. AMA Arch 1971 Otolaryngol 1952 56 610-615 In 1958, John J. Shea, Jr., revived the long abandoned concept of stapedectomy for the surgical treatment of otosclerosis.1 Unlike Blake and Jack earlier in this century, Shea covered the opened oval window with connective tissue and reconstructed the impedance transfer of the...
Classification of Perilymphatic Fistula
Pathologic Congenital Cholesteatomas Neoplasms particularly tumors of the mastoid or skull base Middle ear infections Mastoid infections Stapedectomy and stapedotomy Traumatic Implosive Barotrauma SCUBA diving Rapid descent in aircraft Acoustic trauma e.g., exposure to loud noise or explosions Explosive Head and neck trauma including whiplash Airbag trauma Conditions associated with sudden or sustained increases in intracranial or intrathoracic pressure e.g., heavy lifting, protracted or...
Laser Technique
Although beyond the primary scope of this chapter, it is worthwhile to briefly discuss our laser technique when combined with deep-plane facelifting. We classify our laser technique as moderately aggressive. Because settings vary from instrument to instrument, it is important to realize that wise surgeons will always start at low intensities until they are familiar with the effects of their unit. We use a Luxar CO2 laser. Before surgery, we mark the deepest lines of the patient. After prepping,...
Static Rehabilitation Procedures
A static sling procedure is generally indicated when the patient does not desire restoration of facial motion or is not medically fit to undergo a more extensive procedure under general anesthesia. Although static sling procedures do not restore facial motion, they do improve facial aesthetics for the patient by providing facial symmetry at rest and often will improve oral incompetence. Traditionally, a fascial graft, such as fascia lata from the thigh, is harvested and anchored from the...
Historical Aspects
In 1854, Ward1 first described a nasal papilloma. Billroth reported on a recurring nasal papilloma 1 year later, which he called villi-form cancer many others began to look at this peculiar entity that appeared to invert,1-6 as examined microscopically. In his landmark paper in 1971, Hyams1 clarified the confUsion regarding the characteristic growth behavior of IP by demonstrating the prognostic significance of certain histologic features. Hyams showed that increased mitotic activity,...
Conclusion
Several controversies surround the use of END in the treatment of HNSCC. Included are the therapeutic effects of selective procedures and the indications for adjuvant therapies. Ongoing studies are attempting to define the role of SND for the treatment of limited cervical disease. END remains the most accurate tool currently available to stage the neck in HNSCC. Staging provides important prognostic information and targets patients who may benefit from combination therapy. 1. Baredes S, Leeman...
Is Selective Neck Dissection Appropriate for the Treatment of the N0 Neck
It is generally accepted today that a radical neck dissection is not indicated for surgical treatment of the N0 neck.30 However, the preference between selective neck dissection and the modified radical neck dissection type III MRND-III , in which the sternocleidomastoid muscle, the internal jugular vein, and the spinal accessory nerve are preserved, remains controversial. Some surgeons, particularly in Europe, advocate this type of MRND as the treatment of choice for the NO neck, whereas in...