Edward S. Porubsky

Acute laryngeal trauma: a review of 77 patients.

Acute laryngeal trauma is a rare injury. In the past 18 years, 77 patients with acute laryngeal trauma have been evaluated at our institution. Each patients care was overseen by the senior author (E.S.P.). The 61 patients who were seen within 48 hours of their accident are compared with those treated after 48 hours. All patients are classified by both injury (groups 1 through 5) and treatment (types I through III). Results are reported for voice, airway, and swallowing. Our methods of evaluation and treatment are outlined, and controversial aspects of patient management are addressed. We conclude that conservative treatment of group 1 and 2 injuries is 100% effective, expeditious repair of laryngeal injuries greatly reduces poor outcome, and the type of injury can be used to roughly predict patient outcome. Further, with use of current methods of diagnosis and management, almost all patients will be decannulated (98%) with functional speech (100%) and normal deglutition (100%). (OTOLARYNGOL HEAD NECK SURG 1993;109:441-9.)

The Effect of treatment on survival in patients with advanced laryngeal carcinoma

Over the last 2 decades, survival from laryngeal cancer has decreased. We sought to identify factors associated with decreased survival in laryngeal cancer.

Cisplatin and doxorubicin. An effective chemotherapy combination in the treatment of advanced basal cell and squamous carcinoma of the skin.

Eleven patients with advanced basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) of the skin were treated with cis‐diamminedichloroplatinum II (cisplatin) and doxorubicin. Seven patients had prior surgery and six of these seven had prior radiation therapy. All patients had an adequate trial of chemotherapy. One patient received a second course of chemotherapy after relapse. Responses were seen in 10 of 12 (87%) of chemotherapy courses, and 5 of 11 patients (46%) have an unmaintained complete remission lasting 2 to 31 months. Toxicity was acceptable and consisted primarily of gastrointestinal side effects. These results indicate the combination of cisplatin and doxorubicin has significant activity in both advanced BCC and SCC of the skin. In addition, a portion of patients treated with the combination achieve a long‐term unmaintained disease‐free state.

The effect of occult nodal metastases on survival and regional control in patients with head and neck squamous cell carcinoma

Objectives: To determine factors associated with disease‐free survival (DFS) and regional control in clinically node‐negative head and neck squamous cell cancer (HNSCC) patients with occult metastasis.

Acute External Laryngeal Trauma: Experience with 112 Patients:

The purpose of this report is to promote early recognition, expeditious evaluation, and judicious management of acute external laryngeal trauma. A retrospective chart review was performed of 112 cases that were managed at a Medical College of Georgia tertiary care hospital by the senior author (E.S.P.). Patients were classified by the time of their presentation, the severity of their injury, and the treatment protocol followed. The clinical outcomes of airway, voice quality, and deglutition were retrospectively reviewed. For voice outcomes, in the delayed treatment group, only 27.7% of patients had a good result, as compared to a 78.3% good result in the early treatment group. Similar differences were demonstrated regarding the airway. In the delayed treatment group, only 73.3% had good airway function, as compared to 93.3% who had good airway function in the early treatment group. Ninety-nine percent of all patients had a good result for deglutition. We conclude that expeditious diagnosis and intervention reduce the incidence of suboptimal clinical outcomes, and with timely and appropriate application of diagnostic and management protocols, the majority of patients will be successfully decannulated (97%) with functional speech (100%) and normal deglutition (99%).

Management of Subglottic Foreign Bodies

Foreign body aspiration is not an infrequent encounter in the practice of otolaryngology and requires immediate attention. The vast majority of foreign body aspirations occur in children less than 3 years of age, and the actual event of aspiration is frequently not witnessed. Although inhaled foreign bodies most often lodge in the bronchi, laryngotracheal foreign bodies also occur and are potentially more dangerous. Specifically, subglottic foreign bodies present unique clinical challenges. The diagnosis of subglottic foreign bodies is often difficult and they are commonly confused with other causes of upper airway obstruction. We present our experience with the diagnosis and management of seven patients with subglottic foreign bodies, who presented with an abnormal airway and whose problems were initially misdiagnosed. The radiographic and clinical features are discussed with a review of our surgical management.

Harmonic Scalpel versus cold knife dissection in superficial parotidectomy.

OBJECTIVES: Use of the Harmonic Scalpel has recently been described in thyroid surgery, in which it appears to result in decreased operative time and blood loss without increasing the incidence of nerve injury when compared to conventional techniques of vessel ligation and tissue division. We sought to determine whether the use of the Harmonic Scalpel in superficial parotidectomy was associated with a difference in operative time, blood loss, or facial nerve injury compared with conventional techniques. STUDY DESIGN AND SETTING: The medical records of all patients who underwent superficial parotidectomy for benign parotid pathology at the Medical College of Georgia and Veterans Affairs Hospital of Augusta, Georgia, from 1999 to 2002 were retrospectively reviewed. Patients were excluded if they had a history of a bleeding disorder, prior facial nerve weakness, prior parotid surgery, malignant pathology, or required total parotidectomy. RESULTS: Forty-two patients were eligible for inclusion. Nineteen patients underwent Harmonic Scalpel parotidectomy (HS) and 21 patients underwent conventional parotidectomy (control group). There were no significant differences between the 2 groups with respect to demographic data, pathology, or tumor size. Use of the Harmonic Scalpel was associated with a significant reduction in length of surgery (167.5 ± 42.6 min vs. 195.5 ± 37.4 min for controls, P = 0.03) and intraoperative blood loss (37.5 ± 25.8 mL vs. 60.0 ± 37.1 mL for controls, P = 0.03). There were no significant differences between the HS or control groups with respect to postoperative drain output (48.7 ± 33.8 mL vs. 48.0 ± 22.9 mL, respectively, P > 0.05) or facial nerve function. CONCLUSION: Use of the Harmonic Scalpel for superficial parotidectomy is safe and may result in reduced operative time and blood loss compared with conventional techniques. SIGNIFICANCE: A safe alternative to cold knife superficial parotidectomy is presented with the potential benefits of reduced operative time and blood loss demonstrated.

Use of the Harmonic Scalpel in Superficial and Total Parotidectomy for Benign and Malignant Disease

Objectives: Use of the harmonic scalpel in superficial parotidectomy for benign parotid disease has been shown to reduce surgical time as well as intraoperative blood loss. We sought to determine whether similar results could be achieved with the expanded use of the harmonic scalpel in parotidectomy for both benign and malignant disease.

Acute laryngeal trauma in the pediatric patient

We reviewed the evaluation and management of pediatric laryngeal trauma, focusing on the unique characteristics of the immature airway as they affect functional results. The study was based on 91 cases of acute laryngeal trauma managed by the senior author (E.S.P.) from 1973 to 1996. Patients over 15 years old were considered physically mature and excluded. The remaining 10 cases (mean age 9.7) were reviewed in detail and compared to the adult series. Intervention ranged from level I (observation) to level III (open repair with stent placement). Outcome measure was by functional evaluation of swallowing, voice, and airway. Injuries were rated from group 1 (minor trauma) to group 4 (massive laryngeal injury with multiple fractures). Sixty percent fell into group 1 or 2. Conservative management in these patients produced excellent results as measured by decannulation (100%), functional speech (100%), and normal deglutition (100%). Conversely, 2 of the 4 patients with group 3 or 4 injuries had persistent airway and/or voice complications despite more aggressive intervention. As the pediatric larynx is protected by pliable cartilage and a more craniad location in the neck, traumatic laryngeal injuries in children tend to be less severe than those in the adult population. Group 1 or 2 injuries respond well to conservative treatment. However, children with extensive laryngeal injuries may have more long-term sequelae.

Management of Chronic Sinusitis in the Adult Cystic Fibrosis Patient

Cystic fibrosis (CF) is an autosomal recessive disorder affecting exocrine gland function. Although CF was formerly a deadly disease of infants and children, recent improvements in antibiotics, nutritional therapy, and supportive care have extended the median survival to adulthood. Patients with CF often present with sinusitis and nasal polyposis in addition to recurrent pulmonary infections. Although the effectiveness of endoscopic sinus surgery in children with CF has been documented, the treatment guidelines and efficacy in the adult CF patient are unknown. We present a series of 16 adult patients with CF and chronic sinusitis. The majority of patients presented with nasal polyposis and concomitant pulmonary complications. Endoscopic findings are reviewed, with an emphasis on improving pulmonary function following endoscopic sinus surgery. Preliminary findings suggest that endoscopic sinus surgery improves symptoms of sinusitis and exercise tolerance and may delay the progressive respiratory failure that often affects the adult CF patient.