Huma A. Quraishi

Allergic Mucin Sinusitis without Fungus

Allergic fungal sinusitis (AFS) is a distinct clinical pathologic entity that has been recognized for over a decade. The hallmark of this process is eosinophilic allergic mucin with fungal hyphae on histopathology. We have identified a subset of patients who present with a clinical picture similar to that of AFS patients in which fungus could not be demonstrated pathologically or on culture. We present four cases of allergic mucin sinusitis without fungus. A comparison of the clinical presentation of this group of patients with those with AFS will be discussed. Both groups had nasal polyposis and a history of multiple sinonasal procedures. By contrast, the patients with allergic mucin sinusitis were older than the AFS group. All of the patients with allergic mucin sinusitis also had asthma. Treatment was the same for both groups of patients.

Internal jugular vein patency in patients undergoing microvascular reconstruction

The objective of this study was to determine the incidence of internal jugular vein thrombosis in patients undergoing free flap reconstruction and simultaneous neck dissection. Patients underwent Doppler ultrasound examination of their internal jugular veins on postoperative days 1 and 7 after functional neck dissection and free flap transfer. Long‐term follow up was obtained at a minimum of 3 months. The incidence of internal jugular vein thrombosis in patients undergoing free flap reconstruction with simultaneous neck dissection is similar to that of patients undergoing just neck dissection. A significant number of these veins recanalize and have excellent long term patency. There does not seem to be a correlation between venous thrombosis and free flap survival.

Endoscopic treatment of allergic fungal sinusitis

Fungal sinusitis has been seen increasingly in immunocompetent individuals. The literature has stressed the importance of diagnosing these cases. Surgical debridement is the treatment of choice. Six immunocompetent individuals with allergic fungal sinusitis were seen at West Virginia University between January 1992 and December 1993. After adequate evaluation, endoscopic surgical debridement was performed. After surgery they were treated with systemic or topical steroids and oral antibiotics for several weeks. Two patients required a second procedure within a year. Four of our six patients had positive fungal cultures for Aspergillus or Curvularia. None of our patients had evidence of invasive disease on histopathology, and systemic antifungal therapy was not required. Patient course and response will be discussed in detail along with a brief review of allergic fungal sinusitis.

Effect of clamp versus anastomotic-induced ischemia on critical ischemic time and survival of rat epigastric fasciocutaneous flap

There are many models used to explore ischemic‐related phenomena. The rat epigastric fasciocutaneous flap model is the one most commonly used. Critical ischemic time is the maximum ischemic insult that tissue can undergo and still remain viable. Experimentally, ischemia is induced either by clamping the vascular pedicle or by dividing the pedicle then performing microvascular arterial and venous anastomosis. We sought to determine what effect the different methods of inducing ischemia have on the critical primary ischemic time and, thus, flap survival.

Laser ablation of respiratory papillomatosis using jet ventilation

provided after surgery, and the postural stability was evaluated by using a force platform posturography before surgery and 1 week, 3 months, and on average 8.3 years after surgery. The body sway velocity (BSW) of VS patients was measured with eyes open, with eyes closed, and during active interference of proprioception. The symptom scale was evaluated with a questionnaire and compared with scores of the healthy subjects. Results: Before surgery the BSW was significantly worsened in all patients and still continued to deteriorate 1 week after surgery. After 3 months the BSW started to decline and returned to preoperative value at 8.3 years. Subjectively, 55.6% of the VS patients had postural difficulties before operation, and all experienced them after operation. The postural difficulties were considered 8.3 years after surgery, causing temporary handicap in 22% and moderate-to-severe handicap in 63% of patients. Conclusion: The postural stability was worsened in patients with VS. Surgery further deteriorated the stability, and the recovery was slow, being still abnormal 8.3 years on average after surgery. Postural instability was a mean complaint in most patients.

Subdural empyema as a complication of sinusitis in a pediatric population

OBJECTIVE Sinusitis is a rare cause of intracranial infection in children. While intracranial complications of sinusitis are rare, the morbidity and mortality remain high. Subdural empyema is recognized as the most common sinogenic intracranial complication. We undertook a review of our cases of subdural empyema and other intracranial complications of sinusitis over the past 8 years at a busy inner city hospital. Our intent was to identify factors that may predispose children to these serious complications. METHODS A retrospective chart review was conducted using ICD-9 codes to identify pediatric patients treated for complications of sinusitis at University Hospital (UH) from 1996 to 2004. Only patients age 18 or younger at the time of admission were included in this study. The following data were collected from hospital medical records: age, gender, past medical and social history, presenting symptoms, history of present illness, microbiology, surgical and medical intervention, and outcome. RESULTS Twelve patients were identified that fit the criteria for this study. The mean age of these patients was 14.1 years, and 10 of our 12 patients were male (83.3%). The most common presenting complaints were fever, headache, altered mental status, orbital cellulitis, nasal symptoms, nausea and vomiting, and photophobia. In the week prior to admission for intracranial complications, nine patients were seen by a physician: five patients were seen in the ER and four by a primary care physician. Subdural empyema was the most commonly observed intracranial complication in this series. Microaerophilic and anaerobic organisms were most commonly identified in this series. Most sinus procedures consisted of endoscopic ethmoid and maxillary sinus drainage. There was a long-term morbidity rate of 16% and a mortality rate of 8%. CONCLUSIONS Three conclusions may be drawn from this study. First, the morbidity and mortality of intracranial complications of sinusitis remain high in the pediatric inner-city population despite adequate access to medical care. Second, subdural empyema appears to arise in the setting of subacute rather than acute frontal sinusitis. Lastly, there may be an under-diagnosis and delay in treatment of patients with frontal sinusitis, resulting in subsequent intracranial complications.

13: Effect of Anemia on Primary Ischemic Time in Free Flaps

Otolaryngologists are frequently presented with traumatic or surgical defects that require replacement of missing tissues to achieve optimal functional results. Although autologous or allogeneic tissue, aUoplasts, and metals have been used in various combinations successfully, each of these materials has drawbacks. In an effort to improve and expand our armamentarium, several researchers have demonstrated reproducible results growing cartilage or bone for host tissue replacement using tissue-engineered cell-polymer constructs. Studies have demonstrated that chondrocytes and osteoblasts implanted onto a synthetic mesh can produce mature cartilage or bone when grown subcutaneously in the nude mouse. Tissue produced in this fashion may require additional shaping to be suitable for use in specific defects. To determine whether mature cartilage and bone grown using a standardized cell-polymer construct will reliably retain their shape and tissue integrity after harvesting, shaping and reimplantation, the following study was designed. Using standard tissue-engineering techniques, 25 nude mice were implanted with a 1 cm 2 of synthetic mesh seeded with chondrocytes. Similarly, 25 nude mice were implanted with osteoblast-seeded mesh. After 6 weeks the tissue blocks were removed and carved into a two-dimensional seven-sided figure, similar to an incus. The tissue was photographed for digital analysis and reimplanted in nude mice, for a total incubation time of 20 weeks. At 20 weeks the tissue was again removed. Analysis with digital photography was performed for gross retention of size and shape, with 20% change considered significant. The tissue was also examined histologically for confirmation of mature cartilage and bone in each respective group. In this manner a custom bony or cartilaginous prosthesis could be tissue-engineered. The results of this study will be presented in detail, along with implications for future direction of tissue-engineering studies.