Arnold E. Katz

An Interlocking Auricular Composite Graft

BACKGROUND Full‐thickness defects of the nasal alar rim are relatively common following Mohs micrographic surgery for the treatment of long‐standing or recurrent skin tumors. Composite grafts provide an excellent cosmetic and functional alternative for the repair of such defects. OBJECTIVE A useful technique of auricular composite graft placement for reconstruction of full‐thickness nasal alar rim defects is described. METHODS The cartilaginous portion of the graft is extended beyond the borders of the soft tissue defect so that two cartilaginous pegs frame the lateral aspects of the graft. These pegs are then inserted into pockets prepared within the alar tissue of both sides of the defect, such that the graft interlocks with its recipient bed. A series of diagrams as well as a set of photographs from a representative case are provided, along with accompanying commentary, so as to enable the surgeon to incorporate this technique easily into his/her practice. CONCLUSTION The interlocking auricular composite graft technique permits increased graft stability, with decreased shearing forces of the graft over its recipient bed, and a larger surface area for revascularization, resulting in an increased probability of graft survival. This technique provides an elegant single stage alternative to current reconstructive techniques for full‐thickness nasal alar rim defects measuring less than 1.5 cm in diameter.

Tumor regression and temporary restoration of immune response after plasmapheresis in a patient with recurrent oral cancer.

A major response to plasmapheresis is reported in a patient with advanced, recurrent squamous cell cancer of the oral cavity, similar to that previously reported in three of six comparable patients. Tumor regression followed temporary reduction of inhibition of normal lymphocyte response to phytohemagglutinin (PHA) by the patients serum (from 99% to zero) and partial restoration of the patients lymphocyte response (from 2% to 38% of control). The IgE level rose both overall and during some exchanges; this correlate of tumor response had been noted earlier. The tumor showed extensive necrosis, but the clinical effects were relatively short‐lived and the patient died 11 weeks later. Biopsy specimens taken early in apheresis showed intense new infiltration of tumor by lymphocytes and monocytes; later biopsy specimens showed predominantly plasma cells with trapping and lysis of tumor cells. No other anti‐cancer therapies had been used for 16 months before this trial, and no replacements were given other than saline and albumin.

Induction bleomycin infusion in head and neck cancer.

TWENTY-ONE MALE PATIENTS WITH previously untreated advanced squamous cell carcinoma of the head and neck were treated with an induction regimen of bleomycin 15 mg/m2 I.V. bolus followed by a continuous 24-hour I.V. infusion at a dose of 15 mg/ m2/day for 7 days. One week following induction therapy, patients were reevaluated for response and then received definitive therapy with surgery and/or radiation therapy. The chemotherapy yielded a major response rate of 33% (one CR, six PR). Toxic manifestations of this regimen were mild, consisting of fever, alopecia, rash, and mucositis. There was no pulmonary toxicity detected. The response rate obtained with bleomycin infusion is inferior to the combination of cis-platinum with a bleomycin infusion as induction therapy in previously untreated patients with squamous cell carcinoma of the head and neck.

9:10 am A Porcine Epistaxis Model: Hemostatic Effects of Octylcyanoacrylate

Problem: While epistaxis is common, the lack of a validated animal model has limited the pre-clinical evaluation of new therapies. We developed a standardized porcine epistaxis model and evaluated the hemostatic effects of octylcyanoacrylate (OCA). Methods: A variety of methods of creating nasal septal mucosal wounds were evaluated on one pig, of which only a surgical punch was found to be reliable. Two standardized full-thickness wounds were then created over the anterior-inferior portion of the nasal septae of each of 6 pigs using a 4-mm surgical punch. The time to hemostasis was determined for nontreated control wounds and those treated with a topical OCA formulation. The animals were then fully heparinized and 2 additional wounds were created in each animal, one of which was immediately treated with OCA while the other was allowed to bleed for 10 minutes and then treated with octylcyanoacrylate. Wounds were observed for 24 hours to determine rates of re-bleeding. Results: The total number of punch wounds created was 24, half of which were created after full heparinization. The mean time (SD) from injury to hemostasis in control wounds was 4 minutes, 19 (23) seconds. Complete and sustained hemostasis was achieved in all wounds treated with OCA. The mean time (SD) from injury to hemostasis in wounds treated with OCA was 123 (112) and 101 (117) seconds with and without prior heparinization, respectively, both of which were significantly faster than control wounds. Prior heparinization had no effect on time to hemostasis in treated wounds (t test, P 0.89). In many cases, hemostasis was observed immediately with OCA application. None of the wounds required more than 3 applications of OCA. Conclusion: Topical OCA is an effective hemostatic therapy for epistaxis. Significance: We describe a simple and reproducible animal epistaxis model and demonstrate that OCA is effective in achieving hemostasis in this model. Support: This project was not funded.

Mouthgag suspension in tonsillectomy

Although the turbinates have an important nasal function, its enlargement is a frequent cause of nasal obstruction. A comparative study was made in 90 patients who underwent laser CO 2 turbinectomy versus monopolar and bipolar cauterization. Statistically the laser CO 2 turbinectomy was much better than the other two procedures. Clinically the three groups had improvement of the symptoms but the laser CO 2 could be done in the office with topical anesthesia, without nasal packing, and free of bleeding or crusts.

30: Repair of Traumatic Eariobe Clefts: A Simplified Modification

Traumatic earlobe cleft refers to a split or torn earlobe. 1.2 It is the most common acquired earlobe deformity. 3,4 Traumatic earlobe clefts result from wearing heavy earrings. 5,6 The problem may be a complication of torn-out earrings or a result of an earlobe being pierced too low for an earring. 4 Multiple techniques have been described for repairing this deformity. 1-6 The objectives are to repair the split earlobe, to avoid notching of the rim, and to preserve or recreate the earlobe perforation. We describe a simple technique that accomplishes the first two objectives.

51: Dispensing Hearing Aids During Pro-Bono Surgical Missions

Objective: Pro bono surgical missions to underdeveloped countries are no longer rare in the otolaryngologic community and have proved to be uniquely satisfying and wholeheartedly appreciated by the host country. Although the surgical aspects of these trips are usually the most discussed for their charity and educational value, other aspects of our specialty should not be overlooked. On past visits to Guatemala, our team encountered patients with severe-to-profound hearing losses and felt an almost overwhelming frustration at our inability to be of assistance. The purpose of this study was to investigate the feasibility of dispensing hearing aids in this setting of extremely limited resources. Technique: More than 100 hearing aids were donated to our audiologist by friends and families of patients seen at the State University of New York at Stony Brook. Of the 300 patients examined in Guatemala, 35 received audiograms, and 19 were fitted with hearing aids. Donated batteries were provided to the families and to the Fundacion Pediatrica Guatemalteca, which has an extensive network of social workers who regularly travel throughout the country and follow up patients who were operated on or who received hearing aids. Result and conclusion: With donated and/or borrowed equipment, our group was able to provide hearing aids to 12 males and 7 females, ages ranging from 4.5 to 78 years. Seeing the faces of those successfully fitted with hearing aids was as rewarding to our team as completing a difficult reconstruction. This aspect of our specialty should not be neglected on future missions to underdeveloped countries. It does not add greatly to the cost or preparation for the trip but adds immeasurably to the care that can be provided.

Reconstruction of large facial defects after Mohs surgery

Educational objectives: To be familiar with indications for Mohs surgery and to have several options available for facial reconstruction after Mohs surgery.