Eric Thorpe

Vocal Fold Paralysis after Esophagectomy for Carcinoma

Objectives (1) To recognize factors that contribute to vocal fold paralysis (VFP) after esophagectomy. (2) To describe the morbidity associated with VFP after esophagectomy. Study Design Retrospective cohort study. Setting Tertiary care academic medical center. Subjects and Methods The medical records of 91 patients undergoing esophagectomy for malignancy were reviewed (2008-2014). Twenty-two patients with postoperative VFP were compared with 69 patients without VFP with regard to preoperative variables, surgical approach (transcervical vs other), and postoperative outcomes. A subset analysis of cervical approaches was performed, including those where an otolaryngologist assisted. Results There were no significant differences in preoperative variables between patients with and without VFP. Cervical approaches were associated with increased VFP (P < .0001). Recurrent laryngeal nerve (RLN) identification was associated with increased VFP (P = .0001). RLN dissection by head and neck surgeons was associated with decreased VFP (P = .0223). Patients with VFP had longer lengths of stay (P = .0078), higher rates of tracheotomy (P = .0439), and required more outpatient swallow evaluations (P = .0017). Mean time to diagnosis of VFP was 45.6 days (median, 7.5 days). Conclusions Cervical approaches are associated with increased VFP in patients undergoing esophagectomy for malignancy. When cervical approaches and mobilization are required, the inclusion of an experienced cervical surgeon to identify the RLN may improve the rate of postoperative VFP. Patients with VFP after esophagectomy experience significantly more morbidity. Due to the potential delay in diagnosis and treatment of postoperative VFP, routine assessment of inpatient vocal fold function may be beneficial.

Spinal epidural abscess following glossectomy and neck dissection: A case report

Highlights • Lumbar spinal epidural abscess is uncommon following head and neck surgery.• Isolating Klebsiella pneumoniae as the etiologic pathogen is even more rare.• Early diagnosis is paramount with magnetic resonance imaging being the study of choice.• The preferred treatment strategy consists of surgical decompression and drainage combined with intravenous antibiotics.

Ollier Disease of the Lateral Skull Base

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Treatment of locally advanced parotid malignancies with parotidectomy and temporal bone resection

PURPOSE In this study we review our institutions experience and outcomes with temporal bone resection and parotidectomy in the treatment of advanced parotid malignancies. METHODS Patients undergoing lateral temporal bone resection and parotidectomy from 2007-2013 were identified in the EPIC electronic medical record. Primary tumor location, staging, surgical procedure, and patient demographic and outcome data were collected retrospectively. RESULTS Fifteen patients underwent combined temporal bone resection and parotidectomy for parotid malignancy. Carcinoma ex-pleomorphic and squamous cell carcinoma were the most common pathologies. Two year disease free survival was 40%. Distant metastases were the most common site of disease recurrence. Only nodal disease was predictive of reduced disease free survival, though pre-operative facial paralysis showed a trend towards significance. Margin status and operating for recurrent tumor did not influence outcome in our series. CONCLUSION Local and regional tumor controls are attainable with combined skull base approaches to advanced parotid malignancies. Unfortunately these cases have a high rate of distant recurrence despite negative margins and local control.

A Unique Surgical Technique for Tracheostomy in Heterotopic Ossification A Case Report

Objective: To describe a technique for tracheostomy in heterotopic ossification that has not yet been described in the literature. Methods: We report a case of difficult tracheostomy while using conventional techniques in a 68-year-old patient who underwent mitral valve replacement requiring warfarin therapy three months prior. Imaging revealed heterotopic ossification overlying the trachea. A literature review was performed to identify similar cases or techniques. Results: Extensive surgical planning was pursued after the initial attempted tracheostomy failed, and the airway was eventually accessed using a lighted intubation stylet for guidance and a drill. Heterotopic ossification has been described after orthopedic and abdominal surgeries. We identified one case report in the literature of tracheostomy performed in the setting of heterotopic ossification by an unspecified mechanism. There are few reported cases of tracheobronchial calcification in cardiac patients receiving warfarin therapy; however, these patients had characteristic imaging findings that were not consistent with those of our patient. Conclusions: We illustrate a safe and effective technique for tracheostomy in heterotopic ossification that has not been reported. Coordination with the anesthesia service was paramount for a successful operation.

Temporoparietal fascial flap repair of middle cranial fossa tegmen and dural defects

INTRODUCTION The repair of middle cranial fossa tegmen defects, encephalocele, and cerebrospinal fluid (CSF) leaks frequently involve the use of nonvascularized free tissue grafts such as fascial, cartilage, and bone grafts. A number of processes can lead to the development of tegmen and dural defects, including but not limited to cholesteatoma disease, surgical and nonsurgical trauma, and spontaneous CSF otorrhea with or without encephalocele. Success with nonvascularized free tissue graft techniques in achieving primary tegmen repair and control of CSF leak is variable, with failure rates ranging from 2.3% to 28.6%. Cases requiring revision repair or with extensive dural defects should especially consider alternative reconstructive options. In addition, nonvascularized free tissue grafts may have poor viability in an infected field, which can be encountered in cholesteatoma disease. Vascularized tissue grafts offer a robust option in the closure of a variety of skull base defects with control of CSF leak. Patel et al. described their use of the temporoparietal fascial flap in reducing CSF leak after lateral skull base tumor resections. We report our use of the temporoparietal fascial (TPF) flap in a case of middle fossa CSF otorrhea failing multiple previous repairs, and in the case of a large tegmen defect with CSF leak and temporal lobe abscess stemming from middle ear cholesteatoma disease.