Adam S. Jacobson

Vessel-depleted neck: Techniques for achieving microvascular reconstruction†

In the neck, the recipient vessels most frequently used for microsurgical reconstruction are compromised by prior surgery and radiation.

Emerging technology: Flexible CO2 laser WaveGuide

The carbon dioxide (CO2) laser has been a powerful tool in the armamentarium of the otolaryngologist since the early 1970s. In the past, rigid endoscopes and the micromanipulator were necessary to reflect a beam along a direct path to the treatment area. Exposure of the target area was often difficult and general anesthesia was required to gain access to target areas. Recently, OmniGuide, Inc. (Cambridge, MA) has developed a Photonic Band-Gap Fiber Assembly (PBFA) for delivery of CO2 laser energy. This new WaveGuide has the flexibility, maneuverability, and diameter requirements to access lesions and locations that would not be possible using direct visualization. The surgeon is able to apply CO2 laser energy to chosen target lesions in the outpatient clinic through flexible endoscopes. We report our initial experience with the CO2 laser WaveGuide in a case of laryngotracheal amyloidosis.

Enophthalmos as a Complication of Rhinoplasty

Silent sinus syndrome is a known clinical entity caused by negative sinus pressure from acquired obstruction of the maxillary sinus ostium with resulting enophthalmos and hypoglobus. We present a case in which, after septorhinoplasty, a patient developed progressive enophthalmos and hypoglobus. His evaluation was consistent with silent sinus syndrome. This case illustrates the complex reconstructive challenges of repairing an orbit in the setting of fistulization of the orbit with the maxillary sinus cavity. In particular, we highlight the inferior fornyx transconjunctival approach with simultaneous intranasal endoscopic maxillary sinus aeration.