Elie E. Rebeiz

Autofluorescence characteristics of oral mucosa

The fluorescence characteristics of tissues depend upon their biochemical composition and histomorphological architecture, both of which undergo a change during malignant transformation. These changes are detectable as an alteration in the fluorescence spectral profile of the tissues.

Endoscopic Sphenoidotomy Approach to the Sella

OBJECTIVE Advances in optics, miniaturization, and endoscopic instrumentation have revolutionized surgery in the past decade. We report our experience with the endoscope in nine patients with sellar lesions who underwent an endoscopic sphenoidotomy approach to the sella. METHODS An endoscopic transnasal cavity sphenoidotomy approach without a septal dissection was used in the resection of pituitary adenomas and other sellar lesions. RESULTS This approach provided excellent exposure of the sella and adequate working space. The technique produces less postoperative pain and, in some cases, shortens hospital stay. The sphenoidotomy approach eliminates the problems of lip numbness, septal perforations, and oronasal fistulas. CONCLUSION The endoscopic sphenoidotomy approach has become our preferred approach to sellar lesions.

Paranasal sinus development: A radiographic study

Objective To demonstrate the development of the paranasal sinuses in a pediatric population by computed tomography scans.

A 585-nanometer pulsed dye laser treatment of laryngeal papillomas: Preliminary report†

Objectives/Hypothesis: Standard management of recurrent respiratory papillomatosis (RRP) currently consists of CO2 laser microsurgical ablation of papillomas. Because of the recurrent nature of this viral disease, patients are often faced with significant cumulative risk of soft tissue complications. As a minimally traumatic alternative to management of RRP, we have investigated the use of the 585‐nm pulsed dye laser (PDL) to cause regression of papillomas by selective eradication of the tumor microvasculature. Study Design: Nonrandomized prospective pilot study. Methods: Patients with laryngeal papillomas were treated with the PDL at fluences of 6 J/cm 2 (double pulses per irradiated site), 8 J/cm 2 (single pulses), and 10 J/cm 2 (single pulses), at noncritical areas within the larynx, using a specially designed micromanipulator. Lesions on the true cords were treated with the CO2 laser, using standard methodology. Results: Clinical examination of three patients treated to date showed that PDL treatment appeared to produce complete regression of papillomas. Unlike the sites of lesions treated by the CO2 laser, the epithelial surface at the PDL treatment sites was preserved intact. Conclusions: These preliminary results suggest the PDL may eradicate respiratory papillomas with minimal damage to normal laryngeal tissue. Further analysis of the ongoing study is required to demonstrate potential benefits of the technique.

Topical application of mitomycin-C in endoscopic dacryocystorhinostomy.

Endoscopic dacryocystorhinostomy (DCR) is a well-established alternative to external DCR for treatment of obstruction of the lacrimal pathway and has a success rate of up to 95% in primary cases. Despite the benefits of using an endoscopic approach, including enhanced intranasal access to the lacrimal drainage system, there still exists a significant failure rate, particularly in revision procedures. As these failures are mainly due to obstructive postoperative adhesions, intraoperative adjuncts that prevent or minimize scarring should enhance the success rate. Endoscopic DCR was performed with intraoperative topical application of mitomycin-C, an antimetabolite often used in ophthalmologic procedures to reduce scarring and formation of adhesions following surgery. The procedure was successful in 7 of 8 instances, with a follow-up of 3 to 27 months. In one procedure, obstruction recurred 10 weeks after surgery. We feel that the results of this small series are encouraging and that further studies are warranted to determine the effectiveness of mitomycin-C as an adjunct to endoscopic DCR.

Nd-YAG Laser Treatment of Venous Malformations of the Head and Neck: An Update

Malformations of the arterial and venous systems often are manifested in the head and neck. Low-flow venous malformations are generally benign lesions; however, complications, such as bleeding, obstruction, pain, or cosmetic deformities, may warrant surgical intervention. Treatment of these lesions can be challenging. Laser photocoagulation, particularly with the neodymium-yttrium aluminum garnet (Nd-YAG) laser, has been successful in the majority of patients, with minimal morbidity and good results. Thirty-two patients with low-flow venous malformations of the head and neck were treated with the Nd-YAG laser using low-power density and intermittent short exposures in a punctate nonoverlapping technique. When possible, two glass slides were used to compress the lesion. There was excellent regression with minimal damage to the surrounding tissue. No major complications or morbidity, postoperative pain, or mortality occurred. Lesions occurring in some areas of the head and neck would not have been amenable to standard surgical excision. Follow-up period has ranged from 1 to 8 years. Nd-YAG laser photocoagulation has proved safe and effective for treatment of low-flow vascular malformations of the head and neck.

Benign lesions of the larynx : should the laser be used ?

The use of the carbon dioxide (CO2) laser in the treatment of patients with benign laryngeal lesions, excluding respiratory papillomatosis, has been questioned because of potential adverse thermal effects on surrounding tissue. We question whether wound healing and subsequent quality of voice would be better if the surgeon used the “cold technique” with microlaryngeal instruments. Since the advent, in 1987, of a small‐spot (0.3 mm) CO2 laser micromanipula‐tor and more precise microlaryngeal instruments, we have redefined our use of the CO2 laser for benign laryngeal lesions. Over the past 4 years, in a series of 68 consecutive patients with vocal cord nodules, polyps, polypoid changes, or granulomas, the CO2 laser was useful for mucosal micro‐flap dissection techniques and for vascular lesions. Smaller pedunculated lesions, such as vocal cord nodules, were more efficiently removed with the new microlaryngeal instrumentation. The combined selective use of a microspot CO2 laser at low‐power settings (1 to 3 W), with 0.1‐second pulses, and with precise microlaryngeal instruments will give the best results.

Endoscopic laser therapy for obstructing tracheobronchial lesions

The Lahey Clinic experience using laser bronchoscopy for relief of obstructive tracheobronchial lesions during a 7-year period from 1982 to 1989 involves 269 patients treated with 400 procedures. The carbon dioxide (CO2) laser was used for tracheal stenosis and granulation tissue. The neodymium:yttrium-aluminum-gamet (Nd:YAG) laser was used for all obstructing endobronchial neoplasms. Indications for therapy included severe dyspnea, hemoptysis, and postobstructive pneumonitis. All patients had relatively central lesions. A rigid bronchoscope was used to treat 88% of patients, and 12% of patients were treated with a flexible bronchoscope. One death occurred during the intraoperative period. Eleven deaths occurred within 1 week of therapy and were related to the presence of extensive malignant lesions or to coronary artery disease. Our experience indicates that bronchoscopic application of the CO2 or Nd: YAG laser affords effective palliation for patients with obstructive tracheobronchial lesions. The Nd:YAG laser is recommended for patients with bulky vascular endobronchial neoplasms, and the CO2 laser is best reserved for patients with benign tracheal stenosis and granulation tissue.

Holmium: Yttrium aluminum garnet laser‐assisted endoscopic sinus surgery: Laboratory experience

Endoscopic sinus surgery using a holmium: yttrium aluminum garnet pulsed solid-state laser oscillating at 2.1 μm with fiberoptic delivery was performed in the laboratory, and the results were compared with those of conventional endoscopic sinus surgery. Three beagle dogs, six human cadaver heads, and one calf head were used in the in vivo and in vitro studies to evaluate the bone ablation, tissue coagulation, and hemostatic properties of the holmium: yttrium aluminum garnet laser. Modified endoscopic telescopes for sinus surgery, a newly developed handpiece for fiberoptic delivery, and other surgical instruments were used

Transtympanic endoscopy of the middle ear

Modern optical technology has made available fiberoptic and rigid endoscopes with diameters of 2 mm and less with acceptable resolution. Endoscopes of small caliber were introduced through a strategically placed myringotomy or an existing perforation to perform exploration of the middle ear as an in‐the‐office procedure. This technique is now routinely used as an adjunct in the diagnostic evaluation of patients with suspected middle ear conditions. Exploratory surgery of the middle ear may be avoided or definitive procedures may be planned better based on endoscopic findings.