Dale H. Rice

Autologous Fat Injection for Vocal Fold Paralysis: Long-Term Histologic Evaluation

Many techniques have been developed for medialization of the paralyzed vocal fold. The purpose of this study is to evaluate autologous fat as an alternative to alloplastic substances for use in vocal fold medialization. Eight dogs underwent left recurrent laryngeal nerve sectioning. Autologous fat was harvested, and the paralyzed vocal fold was medialized by injecting the fat into the thyroarytenoid muscle. The animals were divided into three groups for evaluation at 1, 3, and 6 months. Videolaryngoscopy was performed prior to sacrificing the animals. The larynges were sectioned coronally, and histologic studies were performed. The studies confirmed the preservation of viable fat at the injected site in all animals. Only a minimal inflammatory response was observed in the 1-month group. It would appear that fat injection is a viable alternative to Teflon injection and thyroplasty; it eliminates the need for alloplastic materials, does not appear to migrate, and does not require an open procedure.

Idiopathic facial nerve paralysis: A randomized double blind controlled study of placebo versus prednisone

Idiopathic facial nerve paralysis (IFNP) is a common malady. Because its etiology is unclear, there are a variety of treatment options. Studies to date have not clearly established the benefits of treatment with oral steroids (prednisone).

Presentation and management of neck abscess: A retrospective analysis†

A retrospective analysis of deep neck abscesses managed at the Los Angeles County‐USC Medical Center was performed. Fifty‐one patients met the criteria and were reviewed as to presentation, etiology, location, and microbiology. Hemolytic streptococci and anaerobic species, especially Bacteroides and peptostreptococci, were the most common organisms isolated. Intravenous drug abuse was the most common etiology, and was an important source of primary carotid space infection. This group was most commonly infected with Streptococcus species (50%).

Endoscopic sinus surgery: results at 2-year followup.

Endoscopic sinus surgery is a relatively new technique for the management of sinusitis refractory to noninvasive therapy. Success depends on the use of newly developed instruments, including the endoscopes, that allow one to enlarge the natural drainage ostia of the Involved sinuses. Furthermore, its use assumes that the mucosal disease is reversible and that destructive procedures, such as the Caldwell-Luc, are unnecessary. To date there have been no reports in the English literature of patients followed for more than a few months. Herein we report 100 consecutive patients followed for at least 2 years.

Transmaxillary approach to the anterior cavernous sinus: a microanatomic study.

OBJECTIVE: Several approaches to expose the anterior cavernous sinus have been used, such as frontotemporal, orbitofrontal, anterior subtemporal, and various transfacial approaches. In an effort to gain exposure to the anterior cavernous sinus without necessitating a craniotomy or wide transfacial exposure, the authors in the present study have developed a transmaxillary approach to the cavernous sinus. METHODS: The approach was developed using data obtained by performing 24 cadaveric dissections. Using a sublabial incision to expose the maxilla, maxillotomy is performed and the course of the infraorbital nerve is identified as a guide to the maxillary branch of the trigeminal nerve. After an osteotomy of the posterior sinus wall and pterygoid plate, the foramen rotundum is identified, which lies a mean of 10 mm from the posterior wall of the maxilla. A superomedial enlargement of the foramen rotundum is then undertaken to ultimately expose the anterior cavernous sinus. RESULTS: This technique offers access to all cavernous cranial nerves, as well as the entire course of the anterior loop of the internal carotid artery to the origin of the ophthalmic artery. With a mean operative range of 38 mm from the posterior wall of the maxilla to the anterior loop of the internal carotid artery, this approach offers adequate exposure with a short operative distance. CONCLUSION: The approach may be useful in limited exposure of tumors of the anterior cavernous sinus and some intracavernous vascular lesions.

Use of AlloDerm for coverage of radial forearm free flap donor site

Objectives To evaluate and discuss the role of acellular human dermal matrix (AlloDerm, LifeCell Corp., Branchburg, NJ) graft for coverage of radial forearm free flap donor site.

Intraoperative recurrent laryngeal nerve monitoring.

Intraoperative nerve monitoring has become common for surgical procedures in which cranial or peripheral nerves may be compromised. Intraoperative monitoring of recurrent laryngeal nerve function can be accomplished by recording electromyographic activity from fine-wire electrodes placed in the vocalls muscle. The technique and instrumentation for this are adapted from those used In intraoperative facial nerve monitoring for acoustic neuroma excision. Specifically, a commercially available instrument, the XOMED-NIM provides the capability for monitoring the vocalls muscle electromyogram by means of visual and auditory display. It also provides the capability for performing evoked electromyographic tests of nerve integrity. Intraoperative monitoring of the recurrent laryngeal nerve during thyroidectomy may assist in the more precise dissection of the nerve as well as in verification of nerve integrity during the operative procedure, thus reducing the risk of injury.

Safety of thyroidectomy in residency: A review of 186 consecutive cases

A retrospective review was performed to assess the surgical complications of thyroidectomy performed by otolaryngology residents under close supervision by faculty. One hundred eighty‐six consecutive cases of thyroidectomy performed by the residents in the Department of Otolaryngology—Head and Neck Surgery at the University of Southern California were reviewed. Sixty‐nine percent of thyroidectomies were performed for malignant or possible malignant diseases, and 31% were performed for benign conditions. Transient (less than 2 weeks in duration) hypocalcemia occurred in 26% of the patients; the vast majority of cases resolved within the first week. Five percent of the patients developed persistent hypocalcemia requiring prolonged replacement therapy. The incidence of unexpected postoperative permanent vocal cord paralysis was 0.9%. These complication rates are comparable to those in previously published large series on results of thyroidectomy. Thyroidectomy performed in an otolaryngology residency training program is a safe procedure when closely supervised by experienced faculty.

Osteosarcoma and chondrosarcoma of the head and neck

Osteosarcomas and chondrosarcomas are rare malignant neoplasms in the head and neck. Eighteen cases seen at the UCLA Center for the Health Sciences are reviewed. Osteosarcomas of the maxilla tended to occur a decade later than those of the mandible or cranial bones. Several followed prior irradiation for retinoblastoma. Complete excision offers the only realistic chance for cure. Adjuvant therapy has little to offer these patients at this time.

Sensory recovery in noninnervated free flaps for head and neck reconstruction.

Recent studies have reported sensory recovery in innervated (“sensate”) microvascular free flaps used for oromandibular reconstruction. To evaluate the efficacy of sensate free flaps used for head and neck reconstruction, the natural outcome of noninnervated flaps must be known. Data on the natural recovery of sensation in noninnervated head and neck free flaps are lacking in the literature. This study evaluates the degree of spontaneous sensory reinnervation in noninnervated microvascular free flaps used for reconstruction of a variety of head and neck defects. Eighteen flaps were evaluated–9 fibula osseocutaneous and 9 radial forearm. The fibula flapswere used to reconstruct composite defects of the mandible and oral cavity mucosa. The radial forearm flaps were used to reconstruct defects resulting from floor of mouth resection (3), total glossectomy (2), pharyngectomy (1), full‐thickness cheek (1), and facial skin (2). Sensation to pinprick, light touch, and temperature discrimination were tested over the skin paddle at time intervals ranging from 6 to 24 months. The pattern of sensory reinnervation in these noninnervated flaps over time and by location is discussed.