Jean Anderson Eloy

Vessel-depleted neck: Techniques for achieving microvascular reconstruction†

In the neck, the recipient vessels most frequently used for microsurgical reconstruction are compromised by prior surgery and radiation.

The significance and management of incidental [18F]fluorodeoxyglucose-positron-emission tomography uptake in the thyroid gland in patients with cancer.

BACKGROUND AND PURPOSE: Incidental positron-emission tomography (PET) uptake in the thyroid bed represents a diagnostic dilemma. Currently, there is no consensus regarding the significance of this finding or the most appropriate approach to management. The purpose of this study was to determine the significance of incidental fluorodeoxyglucose (FDG) uptake in the thyroid gland on [18F]FDG–positron-emission tomography (FDG-PET/CT) in patients being initially staged for lymphomas and/or cancers other than of thyroid origin. MATERIALS AND METHODS: A retrospective review was conducted on patients who were incidentally found to have focal FDG uptake in the thyroid bed on initial staging for cancer. Patient records were assessed for age, sex, clinical presentation, standard uptake values (SUVmax), on FDG-PET/CT, and CT findings in those patients undergoing FDG-PET/CT, fine-needle aspiration (FNA) cytology, and surgical pathologic examination. RESULTS: Thirty patients were identified with incidental FDG-PET uptake in the thyroid bed from 630 studies performed for evaluation of cancer between March 2004 and June 2006. Complete records were available for 18 patients (6 men, 12 women). Five (27.8%) of 18 patients with incidental focal FDG-PET/CT uptake in the thyroid gland demonstrated papillary thyroid carcinoma on final pathologic findings. The mean and SD of SUVmax was 3.0 ± 1.8 (range, 1.1–7.4) overall, 2.9 ± 1.6 (range, 1.1–6.8) in the patients without malignant growth, and 3.4 ± 2.6 (range, 1.1–7.4) in the 5 patients with papillary thyroid carcinoma. No statistical difference in SUVmax was noted between patients with papillary thyroid carcinoma and patients with benign pathologic findings (P = .63). CONCLUSIONS: Incidental FDG-PET uptake in the thyroid gland in patients with cancer of nonthyroidal origin is associated with a 27.8% risk for well-differentiated thyroid carcinoma; however, there seems to be no correlation between intensity of FDG uptake and the risk for a malignant process.

Selective neck dissection following adjuvant therapy for advanced head and neck cancer.

In the past, surgeons believed that in order to eradicate regional disease, a radical or modified radical neck dissection was necessary. An evolution in surgical principles and the popularization of primary chemoradiation has raised the questions regarding the role of neck dissection and the extent of neck dissection following therapy. The aim of this study was to determine the efficacy of selective neck dissection (SND) for patients with N2 or N3 disease following treatment with primary radiation therapy or chemoradiation.

Intracranial mucocele: an unusual complication of cerebrospinal fluid leakage repair with middle turbinate mucosal graft.

Cerebrospinal fluid (CSF) leakage is a well-documented complication of endoscopic sinus surgery (ESS). The usual treatment after such an occurrence is immediate repair using either autogenous or alloplastic materials. Autogenous tissues such as turbinate mucosa, septal cartilage and bone with or without mucoperichondrium/mucoperiosteum, fascia lata, and temporalis fascia are all commonly utilized. However, improper use and inadequate placement of autogenous mucosal grafts can lead to avoidable complications. Intracranial mucocele as a complication of CSF fistula repair with autogenous mucosal graft has been documented only once in the literature. We describe a case of intracranial mucocele formation, five years after repair of CSF fistula using autogenous middle turbinate tissue. A 54-year-old white male was referred to our skull base center with a 2-month history of recurrent seizures. Five years prior to presentation, he underwent ESS at an outside institution; the procedure was complicated by a CSF leakage, which was repaired with a middle turbinate mucosal autograft. Nasal endoscopy revealed hyperplastic inflammatory polyps and a right superior ethmoid mass. Magnetic resonance imaging (MRI) of the paranasal sinuses demonstrated an expansile lesion at the anterior skull base with morphological appearance suggestive of an ethmoid mucocele extending into the intracranial compartment (Fig 1). The signal characteristics of this lesion appearing hyperintense on the T1-weighted image (WI) and hypointense on T2-WI were consistent with high-proteinaceous debris within the mucocele. The patient underwent sinus debridement and mucocele excision via a combined transnasal endoscopic and subcranial approach to the anterior cranial fossa with multilayered autogenous fascia lata and vascularized pericranial flap reconstruction. His postoperative course was uncomplicated, and he was discharged home on the third postoperative day. The patient is currently doing well clinically without radiographic evidence of recurrence after two years.

Enophthalmos as a Complication of Rhinoplasty

Silent sinus syndrome is a known clinical entity caused by negative sinus pressure from acquired obstruction of the maxillary sinus ostium with resulting enophthalmos and hypoglobus. We present a case in which, after septorhinoplasty, a patient developed progressive enophthalmos and hypoglobus. His evaluation was consistent with silent sinus syndrome. This case illustrates the complex reconstructive challenges of repairing an orbit in the setting of fistulization of the orbit with the maxillary sinus cavity. In particular, we highlight the inferior fornyx transconjunctival approach with simultaneous intranasal endoscopic maxillary sinus aeration.

Demineralized bone matrix and fat autograft in a rabbit model of frontal sinus obliteration

OBJECTIVE: In this study, we investigate the efficacy of demineralized bone matrix (DBM) as a material for frontal sinus obliteration in a rabbit model. STUDY DESIGN AND SETTING: Twenty-four New Zealand White rabbits were divided into four groups, and the study was carried out to two time periods. Twelve rabbits underwent frontal sinus obliteration with fat autograft, and 12 rabbits underwent the procedure with DBM. At 12 weeks, six control and six study rabbits were killed. The remaining 12 rabbits were killed at 36 weeks. All specimens underwent radiologic evaluation with spiral CT followed by histologic examination for evidence of bony growth. RESULTS: Sinuses obliterated with DBM showed replacement of the sinus cavity by trabecular bone. Histology demonstrated significant progressive replacement of DBM by cancellous bone from 12 weeks (53.3%) to 36 weeks (78.8%). There were no complications observed as a result of the materials used. CONCLUSION AND SIGNIFICANCE: DBM is a prospective material for frontal sinus obliteration. Long-term studies and human trials will further elucidate the role of this material.

Petrous Apex Aspergillosis as a Long‐Term Complication of Cholesterol Granuloma

Aspergillus infection of the petrous apex is a rare and devastating condition. To date, only two such cases have been reported, which resulted from direct extension of chronic Aspergillus otitis media. We present a case of petrous apex aspergillosis occurring years after surgical drainage of a petrous apex granuloma cyst. Because of the potential lethal nature of this condition, aggressive surgical therapy should be considered early in this illness and may provide the best chance for survival.

Comparison of fast-setting calcium phosphate bone cement and fat autograft in a rabbit model of frontal sinus obliteration.

Background Traditionally, chronic obstruction of the frontal recess is managed by frontal sinus obliteration (FSO). This often requires the harvest of abdominal fat as a filler with all of its associated morbidity. In this study, we investigate the efficacy of calcium phosphate bone cement (Craniofacial Repair System [CRS]) as a material for FSO. Methods Eighteen New Zealand white rabbits were divided into three groups and carried out to two time periods. Six rabbits underwent FSO with fat autograft (control group) and 12 rabbits underwent FSO with CRS (study groups 1 and 2, respectively). At 52 weeks, six control and six study rabbits were killed. The remaining six rabbits were killed at 78 weeks. All specimens underwent radiological evaluation with spiral computed tomography (CT) followed by gross inspection. Histological evaluation was then performed to assess bony growth and to evaluate the interface of the sinus wall with the obliterative material. Results Sinuses obliterated with CRS showed complete obliteration radiographically. This was apparent at 52 weeks and remained static at 78 weeks. Histological analysis indicated persistent obliteration of the sinus cavity from 52 to 78 weeks and signs of osteoinduction. There were no complications observed as a result of the operative procedure or the materials used. Conclusion CRS is an alternative to fat autograft for FSO in this noninfected animal model. Further studies are needed to evaluate its long-term efficacy as well as its behavior in chronically infected sinuses.