Alex Kessler

Solitary fibrous tumor of the nasal cavity

Solitary fibrous tumor (SFT) belongs to a group of mesenchymal tumors, 1 first described as a primary spindle cell tumor of the pleura in 1931. 2 Recently, SFT has been reported in various locations with no relation to serosal surfaces. Sites such as the lung, 3 liver, 4 thyroid, 5 sublingual gland, 6 and parapharyngeal space 7 have been reported. SFTs of the upper respiratory tract, including the nasal cavity, paranasal sinuses, and nasopharynx, are extremely rare, with only 9 previously reported cases. 8-11 Most of the tumors involved the nasal cavity with or without extension to the nasopharynx or the paranasal sinuses. We report the tenth case of SFT of the nasal cavity with extension to the maxillary and ethmoid sinuses.

Hypothyroidism following partial thyroidectomy

Objective To compare rates of hypothyroidism following three types of partial thyroidectomy for multinodular goiter. Study Design and Methods All cases of partial thy-roidectomies (hemi-, near-total, or subtotal) carried out at one Israeli and one Russian medical center (1990–2006) were retrospectively studied to determine the incidence of hypothyroidism after each procedure. Results There were 881 near-total, 1538 subtotal, and 1051 hemithyroidectomies (total 3470). Postoperative follow-up was 2 to 15 years. Twenty-eight percent of the hemithyroidectomy patients suffered permanent hypothyroidism compared to 100% of the near-total and 87% of the subtotal patients. Forty-six percent of the hemithyroidectomy patients suffered temporary hypothyroid-ism compared to 100% of the near-total and 93% of the subtotal patients. Conclusion Subtotal and near-total thyroidectomies produced a rate of hypothyroidism close to that of total thyroidectomy compared to 28% after hemithyroidectomy. Significance Partial thyroidectomies provide no decisive advantage over total thyroidectomies in terms of subsequent requirements of supplemental hormone therapy.

Transnasal endoscopic drainage of a medial subperiosteal orbital abscess

Abstract The exact incidence of orbital complications due to sinusitis in children is unknown. However, a medial subperiosteal orbital abscess is the most common serious complication to occur. Surgical intervention is mandatory whenever antibiotic treatment fails. Most authors prefer open surgical procedures such as external ethmoidectomy, while others recommend transnasal endoscopic drainage as the first attempt at sinus decompression. Five out of 12 children with proven subperiosteal orbital abscess and sinusitis on computed tomographic scans failed antibiotic treatment and required surgical drainage. Transnasal endoscopic drainage of the abscess was performed on four patients, while one child underwent external ethmoidectomy. Our experience with endoscopic surgery in these four cases is discussed, along with a brief review of the advantage of this procedure over external surgery.

Platysma myocutaneous flap for intraoral reconstruction: an option in the compromised patient

The platysma myocutaneous flap is an infrequently used flap in head and neck reconstruction. This flap should be considered for reconstruction of small and medium-sized defects of the oral cavity. We present two cases demonstrating the utility of this local flap in reconstruction. Advantages, contraindications and limitations of the platysma myocutaneous flap are discussed.

Agmatine treatment and vein graft reconstruction enhance recovery after experimental facial nerve injury.

Abstract  The rate of nerve regeneration is a critical determinant of the degree of functional recovery after injury. Here, we sought to determine whether treatment with the neuroprotective compound, agmatine, with or without nerve reconstruction utilizing a regional autogenous vein graft would accelerate the rate of facial nerve regeneration. Experiments compared the following seven groups of adult male rats: (A) Intact untreated controls. (B) Sham operation with interruption of the nerve blood supply (controls)

Microbiology of peritonsillar abscess as an indication for tonsillectomy.

No conclusive data are available regarding the influence of the microbial content of a peritonsillar abscess (PTA) on the development of recurrence. We conducted the current study to evaluate the effect of microbiologic growth on the recurrence rate of PTA and the need for tonsillectomy. Of 469 patients with PTA, 295 patients who underwent bacteriologic studies were subdivided into 2 groups, nonrecurrent group (273 patients) and recurrent group (22 patients), and their results were compared. A higher rate of anaerobic growth (10 anaerobic pathogens, 57.1% of total pathogens found) was identified in the recurrent PTA group compared with the nonrecurrent group (39 anaerobic pathogens, 45.8%), with a higher rate of anaerobic growth in the recurrent group in the first episode (60% vs. 45.8% in the nonrecurrent group) (odds ratio, 1.76; sensitivity, 80%; specificity, 45%). Anaerobic bacterial growth correlates with a higher rate of recurrence, and may serve as an additional relative indicator for tonsillectomy. Abbreviations: NPV = negative predictive value, OR = odds ratio, PTA = peritonsillar abscess.

Fibrin glue in initial treatment of epistaxis in hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber disease).

The purpose of the present study was to evaluate the haemostatic efficacy of fibrin sealant in patients with hereditary haemorrhagic telangiectasia (HHT) or Rendu–Osler–Weber disease suffering epistaxis. A retrospective observational study of patients with HHT who were admitted to an emergency room for anterior or posterior epistaxis during May 2000–March 2003. A total of 24 patients were evaluated, of whom 15 were managed with foam nasal packing during May 2000–March 2002 and another nine were treated during March 2002–March 2003 with 0.3 ml fibrin sealant spray (Quixil; Omrix, Belgium). The immediate and the distant results were compared. Immediate haemostasis was achieved in all seven patients treated with fibrin glue, with good healing of bleeding sites, no secondary bleeding, no inflammation, and no plaque or crists. Twelve months of follow-up monitoring (until October 2003) of atrophic changes of nasal mucosa, bleeding frequency and intensity proved absence of atrophy of nasal mucosa and decreased bleeding frequency. In this group, the bleeding episode duration averaged 2 min 35 s since the moment of admittance. In the nasal packing group, we found local swelling, pain, and slow healing of the bleeding site with accidental atrophy of nasal mucosa and no effect on further bleeding frequency and intensity. Removal of nasal packing frequently initiates secondary bleeding. The rates of these side effects were higher in comparison with the fibrin glue group. The bleeding episode duration was also longer. In patients with HHT suffering profuse epistaxis, fibrin glue is more effective and convenient for the patients as compared with foam nasal packing. It is also safer, since it lacks the complications that usually accompany packing as swelling, atrophy of the nasal mucosa, and secondary bleeding provoked by the removal of the pack.

Inferior turbinectomy in children.

Background Inferior turbinectomy on patients of all ages is a controversial procedure. Its effect on children has been reported little in the literature and the few studies that are available involved relatively older children, i.e., >10 years old. Nasal obstruction caused by extensive hypertrophy of the inferior turbinates is not an uncommon observation in the pediatric population. The clinical manifestations might present as snoring, noisy breathing, mouth breathing, and, possibly, sleep apnea. Methods In this study, we followed 227 children >10 years of age who underwent inferior turbinectomy (27 children also underwent a revision of an earlier adenoidectomy), of whom 179 children had significant relief of nasal obstruction at the 1-year follow-up. Results Nocturnal breathing was reported to be more regular and otherwise improved in the 36 children with a suspected history of sleep apnea. Forty-two of 47 children who had thick nasal secretions and did not respond to antibiotic therapy before the operation had significant relief postoperatively. Postoperative complications were few and their number did not exceed that of adults. Conclusions A complete inferior turbinectomy should be considered in children >10 years of age who have hypertrophied inferior turbinates that cause major interference with nasal breathing.

Chronic sinusitis: a sequela of inferior turbinectomy.

Inferior turbinectomy has generated a great deal of controversy among rhinologic surgeons. Proponents of partial and total inferior turbinectomy cite numerous studies of large numbers of patients with subjective relief of nasal obstruction after turbinectomy. Clinical studies critical of turbinectomy have focused on complications such as hemorrhage, crusting, adhesions, and atrophic rhinitis. Our study was undertaken to evaluate the incidence of chronic sinusitis post inferior turbinectomy. Postoperative evaluation by history, physical examination, and computerized tomography of the paranasal sinuses revealed that a significant number of patients who underwent inferior turbinectomy developed sinusitis. Patients evaluated in our clinic for nasal obstruction underwent a detailed history, physical examination along with nasal endoscopy and coronal computerized tomography of the paranasal sinuses. Those patients with nasal obstruction not responsive to medical treatment and without evidence of sinusitis underwent submucous resection and inferior turbinectomy. The incidence, cause, and possible prevention of post inferior turbinectomy sinusitis is discussed in this article.

Massive pleomorphic adenoma of the maxillary sinus: A case report

A case of pleomorphic adenoma of the maxillary sinus in a 78-year-old man with associated mucocele is reported. The diagnosis and treatment of this rare lesion is discussed.