Khalid Ansari

FUNCTIONAL SOFT PALATE RECONSTRUCTION : A COMPREHENSIVE SURGICAL APPROACH

Dysfunction of the soft palate is devastating to the patients quality of life, resulting in unintelligible speech and poor swallowing. Reconstruction of the soft palate is complex because the dynamic fibromuscular structure cannot be duplicated. The efficacy of soft palate reconstruction has therefore been called into question. The purpose of this article is: (1) to describe our comprehensive surgical paradigm for soft palate reconstruction, (2) to provide details of the surgical techniques used, and (3) to report on patient functional outcomes.

Beavertail modification of the radial forearm free flap in base of tongue reconstruction: Technique and functional outcomes

Head and neck oncologists are often confronted with the difficult challenge of balancing cancer cure with the preservation of function when deciding the patients best treatment protocol. This task is especially difficult in cancer of the base of tongue. The purpose of this manuscript is to describe the beavertail modification of the radial forearm‐free flap in base of tongue reconstruction.

Role of primary surgery in the treatment of advanced oropharyngeal cancer

The purpose of this study was to compare survival outcomes of patients with advanced stage oropharyngeal squamous cell carcinoma (SCC) according to surgical and nonsurgical treatments, when stratified by smoking and p16 status.

Trends in Level of Evidence in Facial Plastic Surgery Research

Background: Evidence-based medicine has increasingly become an integral part of clinical research and practice. The purpose of this study was to assess the trends in the level of evidence in leading facial plastic surgery journals in recent years. Methods: All scientific articles within the field of facial plastic surgery published in The Laryngoscope, Archives of Facial Plastic Surgery, Otolaryngology-Head and Neck Surgery, Journal of Plastic Surgery, and Plastic and Reconstructive Surgery from 1999, 2002, 2005, and 2008 were rated for level of evidence. The presence of p values and confidence intervals was also noted. Results: Of 975 articles reviewed, 88 percent were clinical and 88 percent were therapy articles. Overall, there was an increase in the average level of evidence of articles published from 1999 to 2008. There was also a significant increase in the proportion of articles reporting p values and confidence intervals. However, the number of articles containing level 1 or 2 evidence remains low. Conclusions: With the increased demand for evidence-based medicine, facial plastic surgery literature has seen an overall increase in the quantity of higher level evidence research published. However, articles representing level 1 and 2 evidence remain rare.

A Comparison of Anterior vs Posterior Isolated Mandible Fractures Treated With Intermaxillary Fixation Screws

OBJECTIVE To compare complication rates after use of intermaxillary fixation (IMF) bone screws for anterior (ie, symphyseal/parasymphyseal) and posterior (ie, body and angle) mandible fractures. METHODS A retrospective analysis of isolated mandible fractures treated with intraoperative IMF bone screws at 2 major level 1 trauma centers within the Department of Otolaryngology-Head and Neck Surgery at the University of Minnesota. From January 1, 2003, through January 31, 2006, we accrued 53 patients with 67 isolated mandible fractures treated with intraoperative IMF bone screws. These patients had at least 6 weeks of follow-up. RESULTS Twenty-one patients had anterior mandible fractures and 32 had posterior mandible fractures. In the anterior group, there was 1 incident of wound dehiscence, resulting in a total complication rate of 5%. In the posterior fracture group, there was 1 infection (3%), 4 malunions/malocclusions (12%), and 1 nonunion (3%), for an overall complication rate of 19%. The difference between groups for malocclusion rates (12% vs 0%) was significant (P < .001). CONCLUSIONS The IMF bone screw system has a superior speed and safety profile. It produces better occlusion results in anterior mandible fractures and might have a lower overall complication rate compared with arch bars. Given this, IMF bone screws are the preferred modality of intermaxillary fixation in properly selected mandible fractures.

Assessment of the accuracy and safety of the different methods used in mapping the frontal sinus.

INTRODUCTION Frontal sinus obliteration continues to be the gold standard for frontal disease control and is often employed as a last resort of treatment after more conservative therapies fail. Different methods of sinus mapping have been previously reported and include (1) 6-foot Caldwell radiography, (2) sinus probing, and (3) sinus transillumination. Image-guided technology was recently introduced to clinical practice, but its utility in frontal sinus mapping has not been evaluated. OBJECTIVE To assess the accuracy and safety of the previously reported methods of frontal sinus mapping and compare them with image-guided mapping. STUDY DESIGN Five cadaveric heads were used. The four mapping methods were applied to each head along five different axes of the frontal bone: 0, 45, 90, 135, and 180 degrees. The true frontal sinus margin was ascertained. Measurements were made from the true sinus limits to the margin points estimated by the four frontal sinus mapping methods. RESULTS The image-guided mapping method provided was the most accurate when compared with the other mapping methods (p < .01). The image-guided mapping method was also the least likely to overshoot the real margin compared with the other mapping methods (p < .001). The template method was the least accurate and least safe method. CONCLUSIONS Image-guided mapping is the most accurate and safest method of mapping the frontal sinus margins.

Acoustic rhinometry and video endoscopic scoring to evaluate postoperative outcomes in endonasal spreader graft surgery with septoplasty and turbinoplasty for nasal valve collapse

BackgroundNasal obstruction is a common complaint seen by otolaryngologists. The internal nasal valve (INV) is typically the narrowest portion of the nasal cavity, and if this area collapses on inspiration the patient experiences significant symptoms of nasal obstruction. The nasal obstruction is further compounded if the INV is narrower than normal. Previous studies have evaluated the effectiveness of techniques to alleviate structural nasal obstruction, but none have looked specifically at spreader grafts measured by acoustic rhinometry or validated grading assessment of dynamic INV collapse. Our objective was to evaluate the application of acoustic rhinometry coupled with visual endoscopic grading of the INV, and validated subjective measurements, in patients undergoing endonasal spreader graft surgery with septoplasty and turbinoplasty.MethodsThis is a prospective clinical study conducted within a tertiary care rhinoplasty practice. Patients undergoing septoplasty and bilateral inferior turbinoplasty with bilateral endonasal spreader graft placement for observed internal nasal valve collapse were recruited. Baseline, early and intermediate postoperative measures were obtained. The primary outcome was grading of the INV collapse on video endoscopy. Secondary outcomes included cross-sectional area at the INV measured by acoustic rhinometry, subjective Nasal Obstruction Symptom Evaluation (NOSE) and Sino-Nasal Outcome Tool (SNOT-22) scores.ResultsA total of 17 patients, average age of 34.5 ± 12.2 years, undergoing septoplasty, bilateral endonasal spreader grafts, and bilateral turbinoplasty were included in the study. Postoperative measurements were performed at an average of 8.1 ± 1.6 weeks and 17.7 ± 4.2 weeks. Patients had significant improvement for INV collapse grading, cross-sectional area, NOSE and SNOT-22 scores in both the early and intermediate follow up. Endoscopic grading had moderate inter-rater agreement (κ = 0.579) and average intra-rater agreement (κ = 0.545).ConclusionsThis study is the first to demonstrate a statistically significant improvement of objective measurement of internal nasal valve function, both static and dynamic, and subjective improvements. This supports endonasal cartilagenous spreader grafts with septoplasty and inferior turbinoplasty for patients with nasal obstruction with internal nasal valve collapse.

Multi-dimensional analysis of oral cavity and oropharyngeal defects following cancer extirpation surgery, a cadaveric study

BackgroundDefects following resection of tumors in the head and neck region are complex; more detailed and defect-specific reconstruction would likely result in better functional and cosmetic outcomes. The objectives of our study were: 1) to improve the understanding of the two- and three-dimensional nature of oral cavity and oropharyngeal defects following oncological resection and 2) to assess the geometric dimensions and the shapes of fasciocutaneous free flaps and locoregional tissue flaps required for reconstruction of these defects.MethodsThis study was an anatomic cadaveric study which involved creating defects in the oral cavity and oropharynx in two cadaveric specimens. Specifically, partial and total glossectomies, floor of mouth excisions, and base of tongue excisions were carried out. These subsites were subsequently geometrically analyzed and their volumes measured. The two-dimensional (2D) assessment of these three-dimensional (3D) structures included measures of surface area and assessment of tissue contours and shapes.ResultsThe resected specimens all demonstrated unique dimensional geometry for the various anatomic sites. Using 2D analysis, hemiglossectomy defects revealed right triangle geometry, whereas total glossectomy geometry was a square. Finally, the base of tongue defects exhibited a trapezoid shape.ConclusionsCustomizing the geometry and dimensions of fasciocutaneous free flaps so that they are specific to the confronted head and neck defects will likely result in better functional and cosmetic outcomes.

Acute Prevertebral Calcific Tendinitis.

We present a case of neck pain in a middle-aged woman, initially attributed to a retropharyngeal infection and treated with urgent intubation. With the help of computed tomography, the diagnosis was later revised to acute prevertebral calcific tendinitis, a self-limiting condition caused by abnormal calcium hydroxyapatite deposition in the longus colli muscles. It is critical to differentiate between these two disease entities due to dramatic differences in management. A discussion of acute prevertebral calcific tendinitis and its imaging findings is provided below.

Objective Assessment of Postoperative Outcomes in Endonasal Spreader Grafts

Objectives: Use acoustic rhinometry to objectively measure the functional outcomes of endonasal spreader grafts in patients undergoing surgical correction of internal nasal valve collapse. Methods: Eighteen adult patients undergoing open septoplasty with unilateral or bilateral endonasal spreader graft placement were recruited. Patients were asked to undergo preoperative and postoperative acoustic rhinometry to measure changes in cross-sectional area of the internal nasal valve. Postoperative subjective nasal symptoms as measured by SNOT-22 and NOSE scores were also compared to preoperative values. Results: Patients undergoing septoplasty with endonasal spreader graft placement had a statistically significant increase in the cross-sectional area of the internal nasal valve (P < .05). This was concomitant with mild improvement in SNOT-22 and NOSE scores postoperatively (P < .05). Conclusions: This study provides objective evidence of an increase in internal nasal valve area after placement of endonasal cartilage spreader grafts in combination with septoplasty.