The Laryngoscope
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The expansion of endoscopic endonasal skull base surgery has resulted in an increased demand for reconstructive options. Reconstruction with vascularized tissue has proven indispensable for reliably separating the cranial contents from the paranasal sinuses following extended endoscopic endonasal approaches (EEA). The introduction of the Hadad-Bassagasteguy flap (vascular pedicle nasoseptal flap, HBF) at our institution decreased our postoperative cerebral spinal fluid (CSF) leak rates from more than 20% to less than 5%. The HBF is not always available, as the nasoseptal area or its vascular supply can be compromised by tumor or prior surgery. In an attempt to keep pace with rapidly expanding reconstructive requirements, we present the anatomic and cadaveric foundations for novel modifications of the facial artery musculo (-mucosal) (FAM[M]) and buccinator flaps to allow vascularized reconstruction of the skull base. ⋯ The transposition of pedicled buccinator muscle flaps with and without mucosa into the nasal cavity could reach the anterior skull base and planum sphenoidale, if the appropriate surgical technique is used. The pedicled Facial Buccinator Flap holds significant potential as a reconstructive alternative for a variety of skull base defects, alone or in combination with existing reconstructive options. 2010.
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Endoscopic balloon dilation is increasingly popular as primary therapy for infants with subglottic stenosis. We aim to determine the maximum balloon diameter and pressure where no fracture of the cricoid would occur, minimum balloon size and pressures where a gross fracture of the cricoid occurs, and location of these fractures. We tested these objectives by performing balloon dilation in laryngotracheal complexes of eight euthanized adult male New Zealand white rabbits, with airway characteristics similar to a 3- to 9-month-old infant. ⋯ No fractures occurred when balloon dilation was performed with a balloon 0.6 mm or smaller than the measured subglottic diameter. Fractures of the cricoid occurred when balloon dilation was performed with a balloon 1.6 mm or larger than the subglottic diameter.
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The purpose of this study was to determine the regional recurrence rate of node-positive oropharyngeal squamous cell carcinoma (OPSCC) in patients undergoing transoral robotic surgery (TORS) and selective neck dissection (SND) followed by observation, radiation, or concurrent chemoradiation. ⋯ SND after TORS resection of primary OPSCC enables the use of selective and deintensified adjuvant therapy to reduce regional recurrence rates.
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Comparative Study
Evaluation of the effectiveness of airway fluoroscopy in diagnosing patients with laryngomalacia.
To re-evaluate the usefulness of airway fluoroscopy (AF) in diagnosing laryngomalacia and to determine the effectiveness of AF in diagnosing laryngomalacia depending on the specific lesion. ⋯ AF is a commonly used modality in the diagnostic workup of a patient with stridor. The effectiveness of AF is limited when compared to endoscopy when used for the evaluation of laryngomalacia.
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Most otoplasty techniques are variations of suturing and sculpting concepts. Thick cartilage and its tricky everlasting reshaping is a difficult task in suture techniques. It is more difficult to predict and control the final result in cartilage sculpting techniques. Animal studies demonstrated temperature-dependent cartilage stress relaxation during laser application resulting in stable shape changes. The aim of this study was to describe a novel surgical technique of carbon dioxide laser-assisted cartilage reshaping (CO(2) LACR) otoplasty and to show its outcome. ⋯ The present technique of CO(2) LACR otoplasty resulted in endurance of auricular appearance and symmetry, with good to satisfactory outcome to patient/parent.