Charles P. Kimmelman

The risk to olfaction from nasal surgery

Implicit in all types of nasal surgery is the potential for worsening of olfactory function. Not only can injury occur to the delicate olfactory neuroepithelium itself, but also more indirect disturbances are engendered by pharmacologic agents, distortions of intranasal anatomy, persistent mucosal edema or crusts, and other processes.

Management of osteomas of the paranasal sinuses.

Craniofacial osteomas are benign tumors of the skull base, often involving the paranasal sinuses. The frontal sinus is the most common site of involvement, followed by the ethmoid, maxillary, and sphenoid sinuses, respectively. The growth rate is very slow, and it may take many years for osteomas to become clinically apparent. The origin of these tumors has been ascribed to embryologic tissue maldevelopment, trauma, or infection. The tumors are hard and lobulated with an ivorylike appearance, often mixed with a coarse granular component. The bone is compact or cancellous, with vascular or connective tissue components. The complications of osteoma growth are obstruction of sinus ostia, extension into adjacent bones and the intracranial cavity, and displacement of anatomic structures. Management of uncomplicated sinus osteomas is controversial, since surgery involves serious potential risks. When surgery is performed, these tumors can be successfully managed via endoscopic, open, or combined techniques. This article reviews the clinical findings, diagnostic studies, and treatment of 16 patients with paranasal osteomas. The indications for surgical intervention are discussed.

Sepragel Sinus (Hylan B) as a Postsurgical Dressing for Endoscopic Sinus Surgery

OBJECTIVE: To assess the safety and efficacy of Sepragel sinus, a hylan B gel (cross-linked hyaluronic acid molecule), when used as a postoperative dressing after endoscopic sinus surgery as a facilitator of healing and a preventative for scarring and stenosis. STUDY DESIGN: Ten patients undergoing bilateral endoscopic ethmoidectomy in an outpatient specialty hospital operating room underwent complete filling of a randomly selected right or left ethmoidectomy cavity with Sepragel sinus. Outcome measures were synechiae, middle meatal stenosis, mucosal status, mucosal regeneration, transparency of Sepragel sinus, and subjective pain and congestion. RESULTS: Sepragel sinus significantly improved all outcome measures by week 2 and remained statistically significant for reduction of synechiae and stenosis. CONCLUSION: Sepragel sinus is useful as a space-occupying gel stent to separate sinus mucosal surfaces. The data strongly support the superiority of Sepragel sinus over no treatment in the control of postethmoidectomy synechiae and middle meatal stenosis, as well as early improvement in mucosal healing and postoperative pain. SIGNIFICANCE: Because of its biocompatibility, lack of inflammatory response, transparency, and ability to fill any complex volume, Sepragel sinus offers distinct advantages over currently used stenting materials.

Risk Factors for Intubation Injury of the Larynx

The endolaryngeal structures are subjected to insult from prolonged endotracheal intubation. Factors that may exacerbate this injury include intubation technique, duration of intubation, tube geometry and constitution, frequency of reintubation, and patient-related factors such as concomitant medical diseases. The contribution of underlying medical disease to laryngeal intubation injury was studied prospectively by sequential endoscopy from the time of tracheotomy. Diabetes mellitus, congestive heart failure, and a history of stroke or tuberculosis increased the likelihood of severe laryngeal injury. The association of these disorders with severe laryngeal injury should lead to consideration of earlier tracheotomy in such patients.

HEAD AND NECK MANIFESTATIONS OF SARCOIDOSIS

The records of 42 consecutive patients with biopsy‐proven head and neck sarcoidosis were reviewed. A female preponderance of 7.4 to 1 was found. The average age at onset for women was higher than that for men (42 vs. 24 years). The presenting signs and symptoms were noted, and correlations between these and the incidence of abnormal chest radiograph and laboratory findings were examined. Pulmonary involvement was most common in patients with periorbital manifestations or cervical lymphadenopathy.

Use of ceftazidime for malignant external otitis

During the past 2 years we have used ceftazidime (Fortaz), a third-generation cephalosporin, in the treatment of eight patients with progressive necrotizing “malignant” external otitis. Ceftazidime is very active against Pseudomonas species and provides penetration into the CSF. Our results suggest that this medication has several advantages over the previously recommended combinations of aminoglycosides and semisynthetic penicillins, including improved cure rate, lower toxicity, and simpler administration schedules. We review our experience with ceftazidime in the treatment of eight patients.

Histopathology of the olfactory pathway due to ischemia

Various agents, such as trauma, viral infections and neoplasms cause olfactory dysfunction. However, little is understood concerning the role of ischemia. An experimental model of brain ischemia was developed in the Mongolian gerbil, and the olfactory pathway was studied. This animal was chosen because of its incomplete circle of Willis, since poor patency of the circle of Willis is not an uncommon finding in the aging human. Ischemia was induced by unilateral ligation of one common carotid artery or temporary occlusion of both common carotid arteries. Under both circumstances, ischemic changes occurred in the lateral olfactory tract, the olfactory ventricle, and the olfactory tubercle. Damage is more severe with bilateral temporary occlusion than unilateral ligation. The olfactory bulbs and neuroepithelium, however, are resistant to ischemia.

Assessment of surgical procedures for ménière's disease†‡

There are numerous surgical procedures for the treatment of Menieres disease, and the current status of their efficacy is controversial. A review of the literature is presented as a basis for the evaluation of the relative merit of these procedures. Emphasis is placed on endolymphatic sac procedures, sacculotomy, vestibular neurectomy and labyrinthectomy.

Head and neck lymphoma in patients with the acquired immune deficiency syndrome.

A marked increase has recently been noted in the incidence of lymphoma in patients with AIDS. These lymphomas are generally high-grade, of B-cell origin, and often involve extranodal sites. Reported here are twenty patients with AIDS in whom symptoms and physical findings developed related to the head and neck region as a result of lymphoma. The tumor was observed in a variety of sites, including the nasopharynx, orbit, submandibular triangle, anterior and posterior cervical triangles, supraclavicular fossa, and the hypopharynx. Sixteen tumors were large cell nonHodgkins B-cell lymphomas, three were small cell nonHodgkins B-cell lymphomas, and one was Hodgkins disease, mixed cellularity. All were treated with combination chemotherapy. A high degree of suspicion for lymphoma is required in treating any patient with AIDS who has a rapidly enlarging mass in the head and neck. If needle aspiration is nondiagnostic, excisional biopsy should be performed after a complete head and neck evaluation. Although the development of lymphoma associated with AIDS portends a grave prognosis, prompt diagnosis will allow an improved chance of remission of the lymphoma.

Inflammatory pseudotumor of the larynx: comparison with orbital inflammatory pseudotumor with clinical implications.

The larynx is an uncommon site of reactive or neoplastic lymphoproliferative disease. Inflammatory pseudotumor of the larynx is a rare benign growth comprised of hyperplastic lymphoid tissue with varying degrees of sclerosis. It is histologically similar to pseudotumors of other anatomic sites, including the orbit, skin, breast, gastrointestinal tract, and lung. The presentation of inflammatory pseudotumors of the larynx ranges from intermittent bouts of hoarseness to airway obstruction and death. Proper diagnosis is often delayed because of the rarity of such lesions in this site. We report a case of pseudotumor of the larynx and review the reported experience with this rare process. Comparison of this lesion to orbital inflammatory pseudotumor suggests pathologic similarity and therefore identifies management options not usually considered.