Gregory G. Capra

Paranasal Sinus Mucocele

Paranasal sinus mucoceles are epithelium-lined cystic masses usually resulting from obstruction of sinus ostia. They most frequently occur in the frontal and ethmoid sinuses. While ophthalmologic symptoms are most common, patients also report rhinological or neurological complaints. The close proximity of paranasal sinus mucoceles to the orbit and skull base predisposes the patient to significant morbidity. Computed tomography displays a non-enhancing homogenous mass with expansion of bony walls. Magnetic resonance imaging reveals variable intensity of T1-weighted images and a hyperintense mass on T2-weighted images. Histopathologically mucoceles have features of respiratory mucosa with areas of reactive bone formation, hemorrhage, fibrosis, and granulation tissue. Surgical excision is the standard treatment with trends towards endoscopic techniques.

Otologic assessment of blast and nonblast injury in returning middle east‐deployed service members

To determine if tympanic membrane perforation offers any protection from inner ear damage and determine the incidence and pattern of otologic blast injury in military personnel returning from deployment.

Antibiotic therapy for pediatric deep neck abscesses: A systematic review

OBJECTIVE To evaluate the current evidence regarding the safety and efficacy of medical management for deep neck abscesses in children. DATA SOURCES Pubmed and Embase databases accessed 3/27/2012. REVIEW METHODS An a priori protocol defining inclusion and exclusion criteria was developed to identify all articles addressing medical therapy of pediatric deep neck abscesses where details regarding diagnostic criteria, specifics of medical therapy and definitions of failure were presented. The search included electronic databases to identify candidate articles as well as a manual crosscheck of references. The level of evidence was assessed and data extracted by three authors independently. Data were pooled using a random effects model due to significant study heterogeneity. RESULTS Eight articles met inclusion criteria. The overall level of evidence was grade C. There was significant heterogeneity among the studies (I(2)=98.8%; p<.001). However, each article uniformly presented cases suggesting that medical therapy may be a viable alternative to surgical drainage in some patients. The pooled success rate of medical therapy in avoiding surgical drainage in children with deep neck infections was 0.517 (95%CI: 0.335, 0.700). When patients taken immediately to surgery were excluded and patients were placed on author defined medical protocols, the success rate increased to 0.951 (95%CI: 0.851, 1.051). Subgroup analysis by duration of intravenous antibiotic trial greater than 48h demonstrated a pooled success rate of 0.740 (95%CI: 0.527, 0.953). CONCLUSION The current literature suggests medical management may be a safe alternative to surgical drainage of deep neck abscesses in children. However, the level of evidence lacks strength and further investigation is warranted.

Malignant melanoma transformation within a nevus of Ito

The mongolian spot, nevus of Ota, and nevus of Ito are the most common morphologic forms of the dermal melanocytoses, a group of benign pigmented lesions histologically characterized by the presence of melanocytes within the dermis. Nevus of Ito is clinically distinct, presenting with unilateral, bluish gray, patchy discolorations in the skin within the distributions of the posterior supraclavicular and lateral cutaneous brachial nerves. Although all dermal melanocytoses are generally considered benign, rare cases of malignant transformation associated with nevus of Ota have been described. Only one case of malignant melanoma transformation in association with nevus of Ito has previously been reported. We present the second description of malignant melanoma transformation within a nevus of Ito and provide comment on the malignant potential of the dermal melanocytoses.

Silicone-Based Endotracheal Tube Causing Airway Obstruction and Pneumothorax

S ilicone-based endotracheal tubes (ETTs) may be prone to intraoperative airway obstruction. The Nerve Integrity Monitoring (NIM) ETT (Medtronic Xomed Inc) is one such tube, and it is used during thyroid and parathyroid surgery for intraoperative electromyographic recurrent laryngeal nerve monitoring. The NIM ETT uses bipolar stainless steel electrodes within the silicone-based tube, which contacts both vocal cords. The specialized tube also uses a silicone elastomer cuff to allow better tracheal conformity and minimal tissue trauma. The designed elasticity may predispose the silicone-based cuff to asymmetrically inflate at very high cuff pressures. While a review of the literature demonstrates a single case report of cuff herniation causing an obstruction of the distal ETT in a clinical situation, the Food and Drug Administration recognizes 8 other reported events. We report a similar case in which ventilation with the NIM ETT was impeded by a herniated cuff, resulting in high positive pressure ventilation and subsequent bilateral pneumothorax.

Surgery for Velopharyngeal Insufficiency

Velopharyngeal inadequacy may be learned, neurologic, or anatomic in origin. Velopharyngeal insufficiency specifically refers to an anatomic deficiency, which subsequently impairs resonant control of speech and intraoral pressure for orally directed speech sounds. Preoperative speech therapy is useful, and in some children may provide definitive treatment. However, surgery is the foundation of effective treatment in most patients with anatomic defects and, when used appropriately, has been shown to result in resolution of velopharyngeal insufficiency in 62-98% of cases. In this chapter, the authors review velopharyngeal inadequacy and discuss the techniques necessary for successful surgical treatment.

National Trends in Pediatric Basilar Skull Fractures

Objectives: (1) Identify the current public health burden of pediatric temporal bone fractures. (2) Determine if the introduction of bicycle helmet and child safety seat laws has resulted in a change in national patterns. Methods: The 2000 and 2009 Kids’ Inpatient Databases were used to gather data on a sample of all pediatric discharges in the United States during the years 2000 and 2009. Children diagnosed with basilar skull fractures were identified by corresponding ICD-9 codes. Database analyses generated national estimates of summary statistics and comparison of trends over the 9-year period. Results: The estimated prevalence of pediatric skull base fractures requiring hospitalization in the United States has remained essentially stable with 9641 (95% confidence interval [CI]: 8782, 10,501) admissions in 2000 and 10,581 (95% CI: 9532, 11,630) in 2009. Likewise, the mean age is unchanged from 10.02 (95% CI: 9.66, 10.38) years to 9.76 (95% CI: 9.44, 10.07). The proportion of female patients is the same (33%) (95% CI: 0.031, 0.34) and (95% CI: 0.0.32, 0.35) respectively. Total charges increased from

Acute Onset Headache and Left Eye Swelling

25,900,000 (95% CI:

Management of the incus body in ossiculoplasty.

22,200,000,

Antibiotics for Pediatric Neck Abscess: A Systematic Review

29,600,000) to