D.J. Verret

Hydroxyapatite Cement in Craniofacial Reconstruction

OBJECTIVES: To evaluate the long-term efficacy of hydroxyapatite cement in craniofacial reconstruction, specifically examining the role (if any) of radiation, implant location, and cement type. STUDY DESIGN: A retrospective chart review was conducted of all patients presenting to the senior surgeon (Y.D.) for craniofacial reconstruction from September 1997 to April 2004. METHODS: Data were collected including type of cement used, size of defect, complications, need for removal of cement, reason for defect, and pathologic results of examination of removed cements. RESULTS: One hundred two patients were identified who underwent craniofacial reconstruction with hydroxyapatite cements, 7 of whom required complete implant removal (6 Norian and 1 Mimix), and 4 (2 Norian and 2 Bone source) of whom required partial implant removal for foreign body reaction. Five of the removals were in patients who underwent postoperative radiation. CONCLUSIONS: Hydroxyapatite cements are safe in craniofacial reconstruction. The highest risk of implant infection comes from reconstruction in the area of the frontal sinus, immediately beneath coronal incisions, and in patients who receive postoperative radiation treatment. Based on our results, there does appear to be a statistically significant difference in rates of infection and foreign body reaction between the different types of hydroxyapatite cement. We would not recommend implantation of this material in contact with the frontal sinus. Caution should be exercised when it is placed directly beneath an incision or in patients receiving postoperative radiation, particularly if a boost dose is given. EBM RATING: C

Endoscopic transantral repair of orbital floor fractures

Objective: To review our technique of endoscopic transantral repair of orbital floor fractures. Study Design: Case series with chart review. Methods: All orbital floor fractures treated with the outlined technique from 1998 to 2007 were reviewed in a retrospective fashion. Demographic data, surgical outcomes, and complications were gathered from available patient charts. Results: A total of 63 patients were treated with the described technique (44 male, 19 female). Thirty-nine patients underwent autograft placement from the anterior maxillary sinus wall harvest/exposure. Fourteen patients underwent placement of various alloplasts, and the remaining 10 patients underwent reduction of the contents and floor repositioning. Two patients underwent repeat repair due to inadequacy of initial repair. Both of these complications occurred in the subgroup of patients who underwent simple repositioning. There were no cases of blindness, permanent new diplopia, ectropion, entropion, or new infraorbital anesthesia. Conclusions: The described technique of endoscopic repair of orbital floor fractures represents a precise method of fracture repair that results in excellent outcomes with minimal morbidity in the majority of patients. It allows for immediate fracture repair without the need to wait for periorbital edema to settle. It also allows for clear visualization of the entire fracture for precise graft placement.

Kaposiform hemangioendothelioma : Case report and literature review

We report the identification of a kaposiform hemangioendothelioma (KH) in the oropharynx of a 3‐year‐old boy. This is a rare endothelial‐derived spindle cell neoplasm affecting children and early adolescents with features common to capillary hemangioma and Kaposi sarcoma. Nine cases of head and neck KH have been reported, this being the first in the otolaryngology literature. Our patient underwent wide local excision and has remained tumor free for over 1 year. KH should be considered in the differential diagnosis of a vascular lesion demonstrating unexpected behavior from that of a hemangioma.

Giant myxomas of the maxillofacial skeleton and skull base

OBJECTIVES: To review our experience with patients diagnosed with giant myxomas of the maxillofacial skeleton. STUDY DESIGN: All patients undergoing excision of myxomas of the head and neck from September 1998 through September 2003 with a minimum follow-up of 1 year by the senior author (YD) were included in the study. METHODS: A retrospective chart review was conducted to select all patients who met the inclusion criteria. Clinical presentation, preoperative radiology findings, excisions performed, reconstruction, and follow-up were recorded and reported. RESULTS: Four patients were identified who met the inclusion criteria. All underwent wide en bloc excision of the tumor with various reconstructions. Complete resection was achieved in each case, and no patients have had evidence of recurrence. CONCLUSIONS: Giant myxomas of the maxillofacial skeleton have been reported to have significant rates of recurrence. Wide en bloc resection with appropriate reconstruction can result in excellent quality of life postoperatively and minimize the risk of recurrence. Lesser resections may not be appropriate especially in giant myxomas because of the potential morbidity that would be associated with a multifocal recurrence.

NODULAR HIDRADENOCARCINOMA OVER THE PAROTID GLAND: A PATHOLOGIC PRESENTATION

Nodular hidradenocarcinoma (NHAC), an eccrine carcinoma, has been reported in the dermatology and pathology literature, but few references have been made in the otolaryngology literature even though the head and neck is a common site of occurrence.

Asymmetric sensorineural hearing loss evaluation with T2 FSE-MRI in a public hospital.

Abstract Conclusions. T2-weighted fast-spin echo magnetic resonance imaging (MRI) can be an economically beneficial protocol for screening patients with asymmetric sensorineural hearing loss without other neurologic findings in a public hospital population. Objective. The goal of this study was to determine if fast spin echo T2 MRI is similar to gadolinium-enhanced MRI in evaluating asymmetric sensorineural hearing loss in a county hospital population. Patients and methods. This was a retrospective chart review of, all outpatients seen at a public hospital, comprising patients with no other cranial nerve findings who underwent gadolinium-enhanced MRI of the internal auditory canal and brain between January 2002 and September 2003. Patients with >15 dB difference in hearing at one frequency or 10 dB hearing difference at two frequencies underwent gadolinium-enhanced MRI scan with FSE T2 sequence as part of the examination protocol. Results. A total of 146 patients were identified who met all the inclusion criteria for the study. Of the 146 MRI scans performed, abnormalities were seen on 71 of them, the majority of which were inconsequential. No acoustic neuromas were identified in our study population. Cost savings of over

Branchio-Oculo-Facial Syndrome With Ectodermal Parathyroid Tissue

100000 would have been realized if only T2 FSE protocols had been used.

Holmium Laser for Endoscopic Treatment of Benign Tracheal Stenosis

Branchio-oculo-facial (BOF) syndrome consists of branchial sinus defects and associated craniofacial, auricular, ophthalmologic, cardiac, and renal anomalies. In addition to the characteristic anomalies, ectopic dermal thymic tissue has been described elsewhere. We present a newly described case of ectopic dermal parathyroid tissue associated with BOF syndrome. Care should be taken before excising skin lesions in patients with the BOF syndrome.

Direct tissue expansion of the contracted nose

Introduction  Laryngotracheal stenosis is a difficult problem with varied etiology and various treatment options. The holmium laser represents another tool for the treatment of benign tracheal stenosis. Objectives  To determine the utility of holmium laser treatment for benign tracheal stenosis with regards to safety and efficacy. Methods  This was a retrospective case study examining patients with benign tracheal stenosis from 1998–2016 who underwent holmium laser treatment. Determining the safety of this procedure was the primary goal, and complications were monitored as a surrogate of safety. Results  A total of 123 patients who underwent holmium laser treatment for benign tracheal stenosis were identified. In total, 123 patients underwent 476 procedures, with follow-up ranging from 1 month to 14 years. No intraoperative or post-operative complications were identified as a direct result of the use of this particular laser. Conclusions  The holmium laser is an effective and safe laser to use for tracheal stenosis treatment. It is a contact laser with a short acting distance, which reduces the risk of injury to distal airway structures. Given the favorable experience reported here, the holmium laser should be considered when tracheal surgery is attempted.

Endoscopic Cauterization of Fourth Branchial Cleft Sinus Tracts

INTRODUCTION Newman, in 1957, was the first to describe the use of inflatable balloons to allow for the expansion of cutaneous tissue for closure of skin defects. Since that time, tissue expansion has been used in many areas of the body, including the face. It provides for closure of defects that would not be amenable to primary closure or where significant donor site morbidity would be created from flap reconstruction. Tissue expansion offers several unique advantages as compared with other reconstructive modalities. It results in skin of similar color, thickness, and hair-bearing characteristics. In addition, sensation is maintained. Tissue expansion may be repeated several times in the same location to provide for additional coverage if this is required.1,2 Tissue expansion does have risks, including implant related problems of extrusion, exposure, and rupture and patient related issues of wound breakdown, infection, hematomas, and cutaneous necrosis. In addition, there is a significant period of prolonged visible deformity during the expansion phase, especially when used in the head and neck. Within the head and neck, tissue expanders have been used in nasal reconstruction, scalp expansion for hair replacement, eyelid expansion, and cheek and neck expansion for repair of defects of the neck and lower two thirds of the face. There have been several previously reported techniques for tissue expansion in nasal reconstruction. They