Gady Har-El

Recurrence rates after endoscopic sinus surgery for massive sinus polyposis.

Background and objectives: Most studies on outcome after endoscopic sinus surgery (ESS) include patients with varying degrees of disease severity. Recurrence rates cited by those studies may not apply to the subset of patients with severe polyposis. Our aim is to provide reference information for recurrence rates and need for revision surgery in patients with severe disease.

Postobstructive Pulmonary Edema After Laryngospasm in the Otolaryngology Patient

Context: Post‐obstructive pulmonary edema (PPE) is an uncommon complication which develops immediately after the onset of acute airway obstruction such as laryngospasm or epiglottitis (type I) or after the relief of chronic upper airway obstruction such as adenotonsillar hypertrophy (type II).

Carcinoma of the Oropharynx: Factors Affecting Outcome

Objectives/Hypothesis: To assess the value of both patient‐ and tumor‐related factors of oropharyngeal squamous cell carcinoma in predicting patient outcome, with respect to the three primary subsites of the disease. It was hypothesized that the subsite has a significant impact on outcome.

Extraorbital skull base idiopathic pseudotumor.

Objectives/Hypothesis: The term idiopathic pseudotumor (IP) refers to a nonspecific, nonneoplastic inflammatory process without identifiable local or systemic causes, which is one of the most common causes of intraorbital space‐occupying lesions. Occasionally, orbital pseudotumors may extend to other areas of the skull base. Rarely, pseudotumors may present as a skull base mass with no involvement of the orbit. The ophthalmology literature has detailed reviews of IP as an intraorbital space‐occupying lesion, but lesions involving only the skull base and sparing the orbit are rare in the literature. We present a review of our experience with six patients with extraorbital skull base pseudotumor and a review of the relevant literature.

Latissimus dorsi myocutaneous flap for secondary head and neck reconstruction

PURPOSEnTo review our experience and results with the use of pedicled latissimus dorsi myocutaneous flap (LDMF) for secondary reconstruction in head and neck surgery.nnnMETHODSnTwenty-two patients had LDMF, 17 of them for secondary reconstruction. Data were collected regarding the primary surgery, primary method of reconstruction, indication for secondary reconstruction, and outcome.nnnRESULTSnSeventeen LDMF procedures were performed for secondary reconstruction. Flap success rate was 100%. Reconstructive goals were achieved immediately in 16 (94.1%) patients.nnnCONCLUSIONnLDMF is a thin flap with a large surface area and a long pedicle that allows it to reach any region in the head, neck, and scalp. Its main disadvantages are the need for lateral positioning of the patient and the fact that its pedicle is not protected with muscle. In our experience, LDMF provides an excellent reconstructive option especially in complicated cases of secondary reconstruction. It may be used in cases where a free flap is usually used, but with significantly reduced surgical time.

Anterior craniofacial resection without facial skin incisions--a review.

ynnterior craniofacial resection (ACFR) has ome a standard procedure for managemen esions of the anterior skull base. ACFR is pr bly one of the only few surgical extirpative p edures in head and neck surgery that expa ur ability to actually remove tumors and incre ure rates during the last 40 years. Most of o ovel surgical procedures in head and neck ery were introduced to increase anatomic unctional preservation and to improve reconst ion, but rarely do they increase extirpative ab ies. The history of anterior skull base surgery eneral, and ACFR in particular, has been be ully summarized by Donald. 1 Dandy reported emoval of an orbital tumor via anterior crani my which included entering the ethmoid co lex. This procedure, which we term today craniotomy only” approach, was followed by R nd McLean, 3 who utilized a combined transorb l-transcranial approach, and by Smith et al, 4 who tilized a combined transfacial-transcranial roach for tumor removal. ACFR as we know oday is based on the original work by Ketcham l. In fact, the “classic” anterior craniofacial r ection we perform today uses the same facial ncisions combined with a bicoronal incision, ell as the same resection steps describe etcham in the 1960’s. The “classic” ACFR h een shown to positively impact treatment of p asal sinus tumors extending to the anterior s ase. 6,7

Determination of the function of the internal branch of the superior laryngeal nerve after thyroidectomy.

Several unique complications of thyroidectomy exist because of its regional anatomy; they are well studied and reported. A majority of thyroidectomy patients report vague upper aerodigestive tract complaints. Despite this, no formal assessment of the integrity of the internal branch of the superior laryngeal nerve after thyroidectomy exists in the literature.

DOES IT TAKE A VILLAGE TO WRITE A CASE REPORT

Editors Note: I believe it is appropriate for readers and authors to consider the following comments by Dr Har-El. The issue of what role the case report plays in peer-reviewed medical journalism is quite appropriate. We in the Journals editorial process have elected to be very selective regarding which submitted case reports are published. Realizing the importance of such publications to young physician authors, we must temper this mission with that of quality and focused scientific literature. Thus we require a strict adherence to our published rules for a case report—short, concise, and to the point, but mainly that it provide a clear educational value to the clinician.

Unusual presentation of a pituitary abscess

We present a case of a pituitary abscess without an identifiable source. The patient presented with progressive visual field defects, unilateral visual loss, and proptosis. However, no symptoms or signs of local or systemic infectious process were present. Computerized tomography and magnetic resonance imaging studies suggested but did not confirm the diagnosis. Emergent transsphenoidal drainage resulted in a complete recovery.

Wegener's granulomatosis of the orbit: Lacrimal gland involvement as a major sign

(Editorial Comment: This unique case reminds us that Wagener’s granulomatosis is a systemic disease that may involve a multitude of head and neck sites. In this case, biopsy-proven involvement of the lacrimal gland necessitated emergent orbital decompression.) Limited forms of Wegener’s granulomatosis (WG) associated with orbital involvement have been described.’ Orbital involvement with WG has an incidence ranging from 40% to 64°h.233 Involvement of the orbit can present as contiguous and/or focal forms. Lacrimal gland enlargement has also been described4; however, biopsy-proven lacrimal gland involvement is rare.