Jared C. Inman

Central segment harvest of costal cartilage in rhinoplasty.

Our objective was to review our experience with a conservative central boat harvest of costal cartilage in patients undergoing rhinoplasty. It involves taking only the central portion of the rib for reconstruction. When cartilage harvest is performed in the above manner, donor site morbidity is minimized without limiting aesthetic results. The key seems to be preservation of intact costal cartilage on three sides, limiting harvest to the central portion only. This central portion is straight and much less prone to warping than the cartilage toward the periphery.

Fracture patterns of the nasal septum

OBJECTIVE: To evaluate fracture patterns of the nasal septum. STUDY DESIGN: Cross-sectional cadaveric study. SETTING: Synthes research laboratories, Philadelphia, PA. SUBJECTS AND METHODS: Eighteen cadavers were divided into three groups. Group A was subjected to low-level force administered to the nasal tip. Group B underwent moderate-level force and group C high-level force. Cadavers subsequently underwent dissection of the nose and nasal septum. RESULTS: Fracture patterns were apparent and related to the force applied. Fracture patterns were classified into three types depending on the location and extent. Group A was the most variable. Three cadavers were classified as type 1, two as type 2, and one as type 3. The average amount of force required to produce a fracture in this group was 100 N. Group B cadavers all developed type 3 fractures. Group C cadavers primarily developed type 3 fractures except for one that developed a type 1. Fractures were further classified in regard to the septum being displaced off the nasal spine. CONCLUSION: Based on our observation, we conclude that fracture patterns of the nasal septum do exist and appear to be related to the amount of force sustained.

Effect of topical dexamethasone versus rimexolone on middle ear inflammation in experimental otitis media with effusion

Conclusion. The lipopolysaccharide (LPS)-induced chinchilla otitis media (OM) model was proven useful in screening anti-inflammatory agents for topical use. Both 1% rimexolone and 1% dexamethasone are effective in reducing the volume of middle ear effusion and mucosal thickness compared with control groups. Topical corticosteroid therapy was efficacious in reducing middle ear mucosal inflammation. Objective. OM is one of the most common diseases in the pediatric population. Our previous studies have shown that treatment with systemic antibiotics and corticosteroids was more efficacious than antibiotics alone. The purpose of this study was to determine the effectiveness of topically applied corticosteroids on the outcome of OM. The long-term goal of this study was to develop a better method of OM treatment by demonstrating effectiveness of topically applied anti-inflammatory agents, such as corticosteroids, avoiding systemic side effects. Materials and methods. Three experimental groups were studied in chinchillas. OM with effusion was induced in all groups by injecting LPS. Group 1 consisted of controls in three subgroups as follows. Control-LPS alone, vehicle of dexamethasone (control-dexa), vehicle of rimexolone (control-rimex). Group 2 was treated with dexamethasone and included subgroups of separate concentrations of dexamethasone: 0.1% and 1% suspensions. Group 3 was treated with rimexolone and included subgroups of separate concentrations of rimexolone: 0.1% and 1% suspensions. A total of 58 animals were used: 18 for controls and 40 for experimental groups. All test substances (saline, control-dexa, control-rimex, dexamethasone and rimexolone, 200 µl) were injected at −2, 48 and 60 h; LPS was injected at 0 h. Animals were monitored by daily otomicroscopy. After 4 days, samples of middle ear effusion (MEE) were collected for analysis and temporal bones were harvested for histopathological studies. Results. At the end of 4 days, only in five ears (3/20 with 1% dexamethasone, 1/20 with 1% rimexolone, and 1/20 with 0.1% rimexolone) had the fluid diminished to the point of being unobservable. The volume of MEE, thickness of mucoperiosteum, and the degree of inflammation of middle ear mucosa with 1% dexamethasone and 1% rimexolone was significantly less compared with other groups.

Incidental Squamous Cell Carcinoma in an Epidermal Inclusion Cyst: A Case Report and Review of the Literature

Epidermal inclusion cysts are common lesions that rarely develop into squamous cell carcinoma (SCC). Neoplastic change in these cysts can be associated with prominent symptoms such as pain, rapid growth, or ulceration. This study describes the case of a 64-year-old woman with a 4-year history of a largely asymptomatic neck mass, which after routine excision was found to be an epidermal inclusion cyst harboring well-differentiated SCC. The diagnosis was made incidentally after routine cyst bisection and hematoxylin and eosin staining. Given the potential for variable presentation and low cost of hematoxylin and eosin analysis, we recommend a low threshold for a comprehensive pathological search for malignancy in excised cysts when appropriate.

Cephalic Vein Transposition in the Vessel-Depleted Neck.

R econstructive techniques following ablative therapy in head and neck surgery have evolved substantially. The untreated neck provides multiple vessels for arterial and venous anastomosis. Challenges tend to arise, however, in previously operated and/or radiated necks where salvage surgical therapy is undertaken. The cephalic vein has become more widely utilized as a suitable recipient vein due to its length and location outside the radiation treatment field. As one would expect, the increased use of this vein has been accompanied by an increasing number of salvage surgical candidates. In this retrospective review, we present our experience, technical approach, and outcomes utilizing cephalic vein transposition in free tissue transfer.

Effect of topical glucocorticoid treatment in chinchilla model of lipopolysaccharide induced otitis media with effusion.

OBJECTIVE To compare the efficacy of topical treatment with three glucocorticoids in lipopolysaccharide induced otitis media with effusion (OME). METHODS Chinchillas were divided into seven treatment groups consisting of vehicle and three glucocorticoids: dexamethasone sodium phosphate (DSP), fluticasone propionate (FP), and hydrocortisone, each at concentrations of 0.1% and 1.0%. LPS (300 μg) was injected into the superior bullae of chinchillas to induce OME. Animals were treated with test substances at -2, 24, and 48 h relative to LPS inoculation. After 96 h, chinchillas were euthanized, samples of middle ear effusion (MEE) were collected, and temporal bones were removed for histopathological examination. Reduction of OME was evaluated by measuring MEE volume and thickness of mucosal lining for each bulla. RESULTS One percent treatment of FP significantly reduced MEE. One percent treatment of DSP and HC significantly reduced the mucosal thickness (MT), DSP (15.0 μM) more than HC (30.8 μM). Treatment with 0.1% glucocorticoids did not lead to any significant reduction. CONCLUSIONS Clearance of otitis media with effusion seems to be a class effect among glucocorticoids. DSP was the best in reducing MT. It is important to evaluate treatment with various glucocorticoids in order to discover alternative drugs for OME.

Esophagram findings in cervical esophageal stenosis: A case-controlled quantitative analysis: Cervical Esophageal Stenosis Quantitative Esophagram Findings

Cervical esophageal stenosis is often diagnosed with a qualitative evaluation of a barium esophagram. Although the esophagram is frequently the initial screening exam for dysphagia, a clear objective standard for stenosis has not been defined. In this study, we measured esophagram diameters in order to establish a quantitative standard for defining cervical esophageal stenosis that requires surgical intervention.

Preoperative imaging for parathyroid localization in patients with concurrent thyroid disease: A systematic review

Thyroid disease occurs more frequently in patients with hyperparathyroidism than the general population and hinders parathyroid localization. Identifying thyroid pathology before operating improves management and avoids the risks of reoperation in the neck. This review assesses imaging studies in patients with hyperparathyroidism and thyroid pathology to identify the ideal imaging methodology for patients with multigland disease.

Open Anterior Skull Base Reconstruction: A Contemporary Review

&NA; Skull base extirpative and reconstructive surgery has undergone significant changes due to technological and operative advances. While endoscopic resection and reconstruction will continue to advance skull base surgery for the foreseeable future, traditional open surgical approaches and reconstructive techniques are still contemporarily employed as best practices in certain tumors or patient‐specific anatomical cases. Skull base surgeons should strive to maintain a working knowledge and technical skill set to manage these challenging cases where endoscopic techniques have previously failed, are insufficient from anatomical constraints, or tumor biology with margin control supersedes the more minimally invasive approach. This review focuses on the reconstructive techniques available to the open skull base surgeon as an adjunct to the endoscopic reconstructive options. Anatomic considerations, factors relating to the defect or patient, reconstructive options of nonvascular grafts, local and regional flaps, and free tissue transfer are outlined using the literature and authors experience. Future directions in virtual surgical planning and emerging technologies will continue to enhance open and endoscopic skull base surgeons preparation, performance, and outcomes in this continually developing interdisciplinary field.

Management of Malocclusion after Maxillofacial Trauma

Abstract Efficacious management of malocclusion following maxillofacial trauma requires understanding of the interaction between teeth and alveolar bone, facial skeleton, temporomandibular joints, and facial neuromusculature. Success is best achieved with a multidisciplinary approach. This article describes the management of malocclusion after primary repair by highlighting important clinical features and offering guidelines for secondary repair through revision surgical reduction, prosthodontic rehabilitation, orthodontic therapy, restorative dentistry, and orthognathic surgery.