Benjamin B. Cable

Pharyngeal flap surgery: long-term outcomes at the University of Iowa.

The pharyngeal flap is the most often used surgical approach to treat the problem of velopharyngeal insufficiency, a common challenge encountered in cleft palate and craniofacial clinics. The authors retrospectively reviewed short-term and long-term measures of children treated with the pharyngeal flap at the University of Iowa Cleft and Craniofacial Center. All patients who underwent pharyngeal flap surgery between January of 1970 and December of 2000, with at least one postoperative speech assessment between 2 and 5 years after the operation, were identified. Both hypernasality and hyponasality were evaluated on a scale from 1 to 6, with 1 indicating no involvement and 6 indicating severe effect on resonance. Velopharyngeal competence was also rated on a scale of 1 to 3, with 1 indicating competence and 3 indicating incompetence. These short-term data were then compared. The results showed that overall resonance performance continues to be adequate and may even improve as the patient continues to grow and mature. These findings support the use of the pharyngeal flap in the treatment of children with velopharyngeal insufficiency.

Pharyngeal Flap Surgery: Protocols, Complications, and Outcomes at the University of Iowa

OBJECTIVEnWe sought to assess complication rates and speech outcomes in patients undergoing pharyngeal flap surgery. Study design and setting We conducted a retrospective chart and database review at a tertiary craniofacial center.nnnPATIENTSnEighty-seven patients were identified as having pharyngeal flaps between January 1990 and December 2000.nnnRESULTSnComplications were rare, with an overall rate of 3.4% for all children. Craniofacial database records were identified with a follow-up examination between 2 and 5 years. Forty-four patients were identified. Of this group, 81.8% demonstrated no evidence of hypernasality or mild hypernasality, and 84.1% demonstrated no evidence of hyponasality or only mild hyponasality. Preoperative and postoperative assessments showed a statistically significant difference in hypernasality at P < 0.001 with no significant difference in hyponasality.nnnCONCLUSIONSnAlthough sphincter pharyngoplasty procedures have gained a great deal of attention in the recent otolaryngologic literature, pharyngeal-flap procedures remain a valuable tool in the hands of surgeons dealing with velopharyngeal incompetence.

Outcomes for children with submucous cleft palate and velopharyngeal insufficiency.

OBJECTIVEnTo review the outcomes of children with submucous cleft palate who also have velopharyngeal insufficiency (VPI).nnnMETHODSnA retrospective chart review was carried out at a tertiary care academic centre of all patients who had VPI with a submucous cleft palate. The University of Iowa Cleft Palate registry parameters encompassing nasality (hyper- and hyponasality) were compared pre- and postoperatively.nnnRESULTSnPreliminary results demonstrate a significant, stable improvement in children who underwent palatal surgery for VPI.nnnCONCLUSIONnPositive outcomes in the treatment of VPI in the submucous cleft palate population were demonstrated with a combined approach of speech therapy and palatal surgery.

The endoscopically assisted pharyngeal flap.

OBJECTIVEnTo describe a modification of the Hogan lateral port control technique for pharyngeal-flap surgery.nnnRESULTS AND CONCLUSIONSnUse of a 70-degree nasal endoscope to assist in the determination of lateral port diameter allows for better control of flap and port construction.

Head and Neck Complications after PCV7 Vaccine Additional Considerations

1. Yue Y, Xiao-lei W, Zhen-gang X, Yue-huang W. laryngeal reconstruction with a sternohyoid muscle flap after supracricoid laryngectomy: postoperative respiratory and swallowing evaluation. Otolaryngol Head Neck Surg. 2014;151:824-829. 2. Allegra E, Franco T, Trapasso S, Domanico R, La Boria A, Garozzo A. Modified supracricoid laryngectomy: oncological and functional outcomes in the elderly. Clin Interv Aging. 2012;7:475-480. 3. Allegra E, Lombardo N, La Boria A, et al. quality of voice evaluation in patients treated by supracricoid laryngectomy and modified supracricoid laryngectomy. Otolaryngol Head Neck Surg. 2011;145:789-795. 4. Garozzo A, Allegra E, La Boria A, Lombardo N. modified supracricoid laryngectomy. Otolaryngol Head Neck Surg. 2010;142:137139. 5. Allegra E, Franco T, Trapasso S, Aragona T, Domanico R, Garozzo A. Quality of life in patients treated by organ preservation surgery for early laryngeal carcinoma. Open Access Surg. 2012;2012:27-32.

Medical Malpractice and the Liability of the Loss of Airway: The Otolaryngology Perspective

Objectives: Analyze malpractice litigation trends to better understand the causes and outcomes of suits involving loss of airway to prevent future litigation and improve physician education. Methods: Jury verdict reviews involving otolaryngologists and loss of airway were obtained from a computerized legal database, WESTLAW from 2001-2011. Data were compiled on the demographics of the defendant, plaintiff, nature of injury, legal allegations, verdicts, and judgments. Results: Fourteen cases were identified and selected for review. Ten cases resulted in mortality, three cases in anoxic brain injury, and one case involved subglottic stenosis. Four cases were found in favor of the defendant, while ten cases resulted in plaintiff verdicts or settlements with an average award of

09:00: RNA Interference Knockdown of TGF-B2 in Human Fibroblasts

1,580,172. Seven cases involved loss of airway due to failed intubations. The most common procedures involved in the loss of airway were oropharyngeal procedures (29%). There were no cases involving a planned surgical airway. The most common legal allegation was delay in procedures (64%). No cases involved failure of informed consent. Conclusions: In cases of loss of airway, there is significant liability consigned to otolaryngologists. They are held accountable for recognizing an emergent airway, promptly and successfully securing the airway, and ensuring a protected airway throughout the patient’s disposition. Thus, close oversight, prompt action, and unequivocal communication in emergent airways is imperative.

P157: Treatment of Cutaneous Hemangiomas with Topical Imiquimod 5%

portional to the growth stage: immature or proliferating tissues showed a higher concentration of SKI, whereas, mature lesions stained less intensely. The endothelial cells which were SKIpositive were involved in active cell division. CONCLUSION: The SKI oncogene protein is differentially and specifically expressed in hemangioma tissues. SKI acts as a transcriptional co-repressor and inhibits the TGF-b pathway, thus leading to uncontrolled cellular proliferation and transformation. All controls were negative for SKI staining. SIGNIFICANCE: The SKI oncogene protein is a new hemangioma-specific marker and is involved in hemangioma tumorigenesis. SUPPORT: Vascular Birthmark Foundation.

R049: Airway Injury Model for the Application of RNAi Therapy

complication of acute otitis media, representing an estimated incidence of 0.005%. However, without appropriate therapy the prognosis is poor. This fact justifies a precise therapeutic protocol to accelerate recovery. METHODS: A retrospective study of all acute otitis media that came in to an emergency unit during the last six years. Six children who presented acute otitis media and facial paralysis were reviewed. Pathophysiological mechanisms and different treatment methods are discussed. RESULTS: The patient ages range from 22 months to 15 years. Facial palsies were identified a few hours to four days from the onset of acute otitis media. Two cases debuted with pain and otorrhea. In the other four cases the tympanic membrane was reddish and swollen. All patients received oral or endovenous treatment (antibiotics and corticosteroides). Myringotomy and local culture was performed in all nonotorrheic patients, except in one whose endovenous treatment immediately improved his paralysis. All patients showed rapid improvement after treatment and recovered completely. CONCLUSIONS: Immediate medical and surgical treatment was crucial to avoid permanent facial paralysis.

R139: Refining Indications for the Use of Mitomycin in the Airway:

airway during the pharyngeal stage of swallowing. But the relationships between mobility of the epiglottis and the hyoepiglottic ligament are not fully understood. METHODS: It is a retrospective comparative study. Hematoxylin-Eosin stain and Elastica Van Gieson stain were performed on paraffin-embedded sections from 20 normal postmortem larynx without laryngeal diseases. The hyoepiglottic ligament was compared between an elderly group (n 11, 81 to 91 yrs old) and nonelderly group (n 9, 31 to 48 yrs old) using an image analysis system (Image J 1.34S). RESULTS: Although it has been believed that the hyoepiglottic ligament anatomically attaches to the anterior surface of the epiglottic cartilage to the hyoid bone, this study showed it extended to the two parts (both lingual muscles and hyoid bone from the epiglottis). The team named the two parts of the ligament as pars lingualis and pars hyoideus. In the elder group, distributions of the muscle fibers, collagen fibers, and elastic fibers were significantly decreased than those in the nonelderly group. CONCLUSION: This study showed that there are age-related differences between elder adults and young adults in the hyoepiglottic ligament. SIGNIFICANCE: This study focused on the hyoepiglottic ligament in order to elucidate age-related changes and its functional characteristics in airway protection during swallowing. Results suggest that active regulation in positioning the epiglottis can be decreased in elders.