Nathan W. Hales

Long-term results of inferior turbinate hypertrophy with radiofrequency treatment: a new standard of care?

Objective: The objective of this study was to report the long‐term efficacy of radiofrequency volumetric tissue reduction (RFVTR) and to compare this with other accepted surgical treatments of inferior turbinate hypertrophy.

Early oral feeding after salvage laryngectomy.

Our aim was to determine the feasibility and safety of initiating early oral feeding in patients who underwent salvage laryngectomy on postoperative day 5 and to review the rate of pharyngocutaneous fistula formation.

Antibiotic resistance and otomycosis in the draining ear: culture results by diagnosis

OBJECTIVE The objective of the study was to better define changes in the bacteriology of suppurative otitis in recent years and the role of cultures in the management of these patients. STUDY DESIGN A retrospective review was performed. METHODS Outpatient records from 170 patients collected over 3 years with information regarding the bacteria cultured, antibiotic resistance, and clinical diagnosis were analyzed. RESULTS A large variety of organisms were seen, with Staphylococcus aureus, Corynebacterium sp, and Pseudomonas aeruginosa being the most common. Forty percent of cultures showed bacteria with moderate antibiotic resistance, whereas 5% were sensitive to only intravenous antibiotics. Resistant bacteria were found in all diagnosis categories and were significantly higher in cases of chronic mastoiditis. The rate of methicillin-resistant S aureus infections was 7.8% and was significantly higher in cases of chronic myringitis. Fungus was often cultured in patients without clinical signs of otomycosis. CONCLUSIONS Community-acquired ear infections may be caused by antibiotic-resistant bacteria in a substantial number of patients. In our opinion, outpatient cultures play an important role in the management of suppurative otitis.

Necrotizing fasciitis secondary to bisphosphonate-induced osteonecrosis of the jaw

Osteonecrosis of the jaw is an uncommon consequence of biphosphonate therapy. This has most commonly been a bone complication with little if any soft tissue involvement. An unusual case of necrotizing fasciitis with extensive soft tissue infection stemming from a prolonged case of osteonecrosis of the jaw presented. The management of this patient (aggressive surgical debridement and prolonged wound care) is reviewed as well as the review of the underlying processes.

Endoscopic resection of a mandibular condyle osteoma: report of a case.

A 55-year-old man presented with dental malocclusion, significant trismus, and inability to chew which had been slowly worsening over the last year. He denied previous trauma or dental/oromaxillary surgery. His physical exam was significant for an open bite on the left side with significant malocclusion. No masses were palpable. A computed tomography scan subsequently revealed an anterior osseous protrusion from the left mandibular condyle, causing displacement from the glenoid fossa (Fig. 1). The patient underwent an endoscopic biopsy of this lesion, which determined it to be an osteoma. He returned to the operating room for an endoscopic approach with resection of the osteoma and recontouring of the condyle. An incision of 1.5 cm was made at the angle of the mandible (Fig. 2). In a subperiosteal plane, a zero-degree endoscope with an endoscopic forehead lift retractor attachment and a freer elevator was used to elevate the soft tissues superiorly along the ascending ramus past the mandibular notch until the entire oral aspect of the condyle and the osteoma were well visualized. Curettes and an endoscopic microdebrider, with a diamond burr attachment, were employed to resect the osteoma. The condylar head and neck were then recontoured. The condylar head reduced nicely into the glenoid fossa and was visually confirmed to be in normal position. The occlusion was evaluated. Hemostasis was confirmed, the wound copiously irrigated, and the incision closed without a drain. In the recovery room, the patient’s mandibular swing was unobstructed and occlusion was noted to be normal. One month after surgery, he was able to eat a regular diet and maintained a normal Class I occlusion. Follow-up computed tomography at this time showed restoration of the normal contour of the condyle region, with head of the condyle appropriately positioned in the glenoid fossa (Fig. 3).

Surgical management of the recurrent laryngeal nerve in thyroidectomy: American Head and Neck Society Consensus Statement

“I have noticed in operations of this kind, which I have seen performed by others upon the living, and in a number of excisions, which I have myself performed on the dead body, that most of the difficulty in the separation of the tumor has occurred in the region of these ligaments…. This difficulty, I believe, to be a very frequent source of that accident, which so commonly occurs in removal of goiter, I mean division of the recurrent laryngeal nerve.” Sir James Berry (1887)

International neuromonitoring study group guidelines 2018: Part II: Optimal recurrent laryngeal nerve management for invasive thyroid cancer-incorporation of surgical, laryngeal, and neural electrophysiologic data: INMSG Loss of Signal Guidelines: Part II

The purpose of this publication was to inform surgeons as to the modern state‐of‐the‐art evidence‐based guidelines for management of the recurrent laryngeal nerve invaded by malignancy through blending the domains of 1) surgical intraoperative information, 2) preoperative glottic function, and 3) intraoperative real‐time electrophysiologic information. These guidelines generated by the International Neural Monitoring Study Group (INMSG) are envisioned to assist the clinical decision‐making process involved in recurrent laryngeal nerve management during thyroid surgery by incorporating the important information domains of not only gross surgical findings but also intraoperative recurrent laryngeal nerve functional status and preoperative laryngoscopy findings. These guidelines are presented mainly through algorithmic workflow diagrams for convenience and the ease of application. These guidelines are published in conjunction with the INMSG Guidelines Part I: Staging Bilateral Thyroid Surgery With Monitoring Loss of Signal.