John G. Bizakis

Laser shaping of composite cartilage grafts

INTRODUCTION The restoration of malformations of different etiology in the head and neck area continue to be a problem to the reconstructive surgeon. Many of these problems are created by the destruction of cartilage. The success of the reconstructive effort very often depends on the selection of a composite cartilage graft of proper size, shape, and thickness, which has to replace the missing cartilage. Despite the best of surgeons intentions, the postoperative result is not always satisfactory due to the difficulty in obtaining a cartilage of the proper shape. Using a carbon dioxide laser, composite cartilage samples 0.4 to 1 mm thick taken from rabbits ears were irradiated. METHODS Rabbit ear cartilage with covering epithelium was used. The thickness of the composite graft measured 0.4 to 1 mm. Specimens were reshaped, treated with a carbon dioxide laser, then immersed in saline. CONCLUSION It was observed that it was possible to change the shape of the cartilage, which then had the tendency to retain its new form for several days. Thicker composite grafts retained the new shape more satisfactorily. The significance of this experiment for future corrective surgery in various parts of the head and neck area is evident. We anticipate that this technique may be useful to mold grafted cartilage for use in complex reconstructions such as nasal, auricular, and tracheal deformities.

Bronchoscopy for foreign body removal in children. A review and analysis of 210 cases

OBJECTIVE A foreign body aspiration in the tracheobronchial tree is a dangerous and common medical emergency in childhood, with serious and potentially lethal consequences. It must be suspected in children with a suggestive history, even though the clinical symptoms or radiographic findings are not pathognomonic for foreign body aspiration. METHODS In this study 210 pediatric cases, with a suggestive history of foreign body aspiration undergoing bronchoscopy in the last 8 years in the department, were reviewed. In all cases bronchoscopy was performed under general anesthesia using a Storz ventilation bronchoscope with distal cold light illumination. RESULTS In 130 patients a foreign body was discovered, in 17 cases pus was aspirated and in 63 cases there were no findings. Seventy-eight (60%) foreign bodies were found in the right main bronchus, 43 (33.1%) in left main bronchus, seven (5.4%) in both bronchi and two (1.5%) were found in the subglottic area. The incidence of bronchoscopy during the last 8 years was 28 procedures per 100000 children population per year in the island of Crete. CONCLUSION More attention should be given to the need for a careful history and the use of radiographs as supplemental information to make the decision to perform a bronchoscopy. The parents, also, should pay attention not to allow children dry fruits and small toys, as well as, teaching their children to avoid any physical or emotional activity while having a full mouth.

Shaping of nasal septal cartilage with the carbon dioxide laser—a preliminary report of an experimental study

Pieces of cartilage 0.5–1 mm thick taken from patients undergoing nasal septal surgery and from the nasal septum and auricle of the rabbit were irradiated using a carbon dioxide laser at 10.6 μm wavelength and a spot size of 1–2 mm. The laser was used both in the pulsed and the continuous wave (cw) mode. In the pulsed mode the pulse length varied from 0.05 to 0.5 s with an average power output of between 1 and 5 W. In cw mode the power varied between 1 and 6 W. It was possible to use the laser energy to mould the cartilage into different shapes which were then maintained after irradiation. These observations have not previously been reported. The clinical significance of this experiment for plastic surgery in the head and neck is discussed.

The silent epidural abscess as a complication of acute otitis media in children

Acute otitis media with complications is a persistent problem in the modern antibiotic era with a relatively high mortality rate. Acute mastoiditis is a serious complication of acute otitis media with potentially grave consequences and the epidural abscess constitutes the commonest of all intracranial complications, arising from middle ear infections. We report two cases of children with acute mastoiditis without evidence of intracranial complication or subperiosteal abscess, in whom the early evaluation with computed tomography (CT) disclosed an unsuspected epidural abscess. Therefore, we stress the use of CT as a rule of thumb for every child with acute mastoiditis.

X-linked deafness with stapes gusher in females.

A 22-year-old woman presented with severe mixed hearing loss and a flow of cerebrospinal fluid in the middle ear during stapes surgery (stapes gusher). HRCT of the temporal bones showed characteristic abnormalities of the inner ear (bulbous dilatation of the lateral portion of the internal acoustic meatus with incomplete separation from the cochlea, and widening of the first part of the facial nerve canal) described in X-linked progressive mixed deafness with stapes gusher. The evaluation of the patients family revealed a sister with the same clinical history and identical HRCT findings, and 11 normal male relatives. This is the first report with typical findings of this entity that affects only female members of a family, suggesting another type of inheritance.

Angiosarcoma of the maxillary sinus.

Angiosarcomas are rapidly growing malignant neoplasms arising from the vascular endothelial cells. Most common sites are the extremities and the retroperitoneal space, with only four per cent of angiosarcomas arising in the head and neck area, whilst the paranasal sinuses are one of the rarest locations. We report the case of a maxillary sinus angiosarcoma in a 72-year-old male patient. The first biopsy was inconclusive, whereas the second revealed an angiosarcoma. Medial maxillectomy was performed with subsequent external irradiation.

Diagnosis and Management of Substernal Goiter at the University of Crete

The objective of this work was to evaluate the diagnosis and management of patients with substernal goiter (SSG) on the basis of our experience. We conducted a retrospective study of all SSGs within a series of 591 thyroidectomies performed in a tertiary referral center over a period of 14 years, analyzing epidemiological data, diagnostic criteria, and surgical results. There were 37 (6%) patients with descending goiter: 28 women (mean age 57.1 years) and 9 men (mean age 61 years). All 37 patients underwent successful surgical treatment without any major postoperative complications. A postoperative histological examination revealed a 16.6% incidence of malignancy. Despite the size and close proximity to vital organs in the mediastinum, all of the SSGs were managed successfully. A neck approach was used in all except for one patient who was operated on via sternotomy. A thorough preoperative evaluation including computed tomography scan of the neck and mediastinum, and an appropriate surgical technique ensure a positive outcome for most patients with an SSG.

Bilateral sudden sensorineural hearing loss caused by Charcot-Marie-Tooth disease.

Charcot-Marie-Tooth (CMT) disease or hereditary motor and sensory neuropathy (HMSN) is a relatively common neurological syndrome, which has seldom been associated with hearing dysfunction, particularly sudden sensorineural hearing loss (SNHL). Families with autosomal dominant, autosomal recessive and X-linked forms of inheritance have been described. Sudden sensorineural hearing loss is a frustrating and frightening condition, especially if the hearing loss is bilateral. Regarding the site of the lesion, the evidence from the literature on HMSN suggests that either the VIIIth nerve or central auditory pathways are primarily involved in patients with hearing loss. We report the first case in the English literature of a patient with Charcot-Marie-Tooth type II disease presenting bilateral SNHL in the course of his disease. The patient was hospitalized for 15 days, and undergoing treatment without any audiological improvement. Detailed clinical, audiological and laboratory examination was performed. The aetiology and prognostic indicators of bilateral SNHL are discussed, as well as, the incidence of hearing loss in CMT patients.

Swiftlase inferior turbinoplasty.

The hypertrophied inferior turbinates are responsible for nasal obstruction in patients with chronic rhinitis. Several methods have been applied to solve this problem. Recently, laser methods have produced good results. We present the management of 387 patients with hypertrophy of the inferior turbinates mucosa, using CO2 laser in combination with the Swiftlase apparatus. CO2 laser energy delivered through the Swiftlase apparatus provides a char-free ablation of a superficial tissue layer. Swiftlase is easily installed onto the existing CO2 laser units and provides a high-power density. The 1-year postoperative follow-up revealed good results in 261 (81%) of 321 patients, thus establishing CO2 laser in combination with the Swiftlase apparatus as a promising new approach for the management of inferior turbinate hypertrophy. CO2 laser energy delivered through the Swiftlase apparatus offers a treatment modality capable of achieving excellent results in hypertrophy of the inferior turbinates with minimal morbidity.

Tailored low dose three-dimensional CT of paranasal sinuses

A technique for three-dimensional (3D) computed tomography (CT) of the paranasal sinuses was evaluated. The influence of milliamperage and reconstruction algorithms on image quality was studied in a phantom. Eleven patients with bony abnormalities of the paranasal sinuses underwent CT to assess the clinical impact of 3D CT protocol. Contiguous 1.5-mm sections obtained at 120 kVp/175 mA/1.9 sec can provide 3D images with high diagnostic image quality. This technique offers the advantage of a much lower dose than that of the conventional CT (CCT) examination of paranasal sinuses. Three-dimensional CT protocol of paranasal sinuses is suggested for use for the evaluation of bony abnormalities and for preoperative planning of the above region.