Parul Goyal

Endoscopic anatomy of the pterygopalatine fossa.

Background The pterygopalatine fossa can be involved with a variety of infectious and neoplastic processes. This region can be entered endoscopically, but endoscopic landmarks to localize the neurovascular structures in the pterygopalatine fossa have not yet been reported. Objectives The purpose of this study is to describe the location of the neurovascular structures in the pterygopalatine fossa in relation to consistent intranasal landmarks. Methods Endoscopic dissections of cadaveric heads were performed. The locations of neurovascular structures in the region were defined. Results The sphenopalatine foramen (SPF) served as the primary intranasal landmark to the pterygopalatine fossa (PPF). Mean distances from the SPF were measured with the following results: SPF to sphenopalatine ganglion (SPG), 4 mm medially and 6 mm laterally; SPF to foramen rotundum (FR), 7 mm; and SPF to vidian canal (VC), 2 mm. The internal maxillary artery followed an irregular and inconsistent course, making it difficult to define a reliable landmark for its location in the fossa. Conclusion Entering the PPF inferior to the horizontal plane of the SPF along a vertical line drawn inferiorly from the infraorbital canal will avoid injury to the major neural structures in the fossa. Because of the inconsistent course and location of the internal maxillary artery, this structure may be at risk no matter where the fossa is entered. These landmarks will allow the surgeon to enter the PPF with more accuracy and less patient morbidity.

The transglabellar subcranial approach for nasal dermoids with intracranial extension.

Objectives/Hypothesis: Nasal dermoids are the most common congenital midline nasal lesions. When a midline nasal pit or cyst is identified, scans should be obtained to look for an intracranial connection. The intracranial portion of the lesions has traditionally been approached by the performance of a frontal craniotomy. The transglabellar subcranial approach is a useful technique to resect these lesions and offers several advantages over a traditional craniotomy approach.

Significant increases of pituitary tumors and resections from 1993 to 2011

Pituitary tumors comprise 10% to 15% of all diagnosed intracranial tumors; 90% are adenomas. Though benign, significant morbidity via compression of surrounding structures or aberrant hormone secretion can occur. This study investigated rates of pituitary tumor diagnoses and treatment trends from 1993 to 2011.

Trends of Online Ratings of Otolaryngologists: What Do Your Patients Really Think of You?

IMPORTANCE The otolaryngologists online reputation is of increasing importance. Physician rating websites are becoming increasingly prevalent, and patients are using them to evaluate their current and future physicians. OBJECTIVE To evaluate patterns in online ratings of otolaryngologists. DESIGN, SETTING, AND PARTICIPANTS From May 1, 2013, through June 1, 2013, lists of academic program faculty members in the Northeastern United States were compiled, and academic allopathic otolaryngologists from the Eastern Section of the Triological Society were identified. Each faculty members name was searched using the Google search engine to link to profiles on the Healthgrades.com and Vitals.com websites. MAIN OUTCOMES AND MEASURES State, program, academic position, years in practice, subspecialty, ratings, and reviews were recorded. Ratings were compared using analysis of variance. RESULTS A total of 281 faculty members from 25 programs were identified. A total of 266 otolaryngologists (94.7%) had a profile on Healthgrades, and 247 (87.9%) had a profile on Vitals. Of those with profiles, 186 (69.9%) and 202 (81.8%) had patient reviews on Healthgrades and Vitals, respectively. The mean score was 4.4 of 5.0 on Healthgrades and 3.4 of 4.0 on Vitals. On Vitals, 179 profiles (63.7%) had comments associated with them. Overall, 49 comments (27.3%) were determined to be negative, and 138 otolaryngologists (49.1%) had at least 1 negative comment. Academic position and subspecialty affected reviews on Healthgrades. State and years in practice did not influence reviews. CONCLUSIONS AND RELEVANCE Most patients use online resources for information on health care professionals. Physician perceptions of these sites tend to be negative. Awareness of the content and rating patterns may help physicians better manage their online reputation.

Endoscopic approach to the infratemporal fossa for treatment of invasive fungal sinusitis.

Background Invasive fungal sinusitis is a progressive disease that can often extend beyond the nasal cavities and paranasal sinuses into surrounding soft tissue and bone. Aggressive antifungal therapy and surgical debridement are the mainstays of management. The pterygopalatine fossa and infratemporal fossa are two regions that are commonly involved in patients with invasive fungal sinusitis. When fungal disease extends to the infratemporal fossa, surgical debridement can be challenging. Traditionally, open approaches have been used for the management of disease in these areas. Advances in endoscopic skull base surgery may allow for less invasive approaches for the management of disease in the infratemporal fossa. This article describes a transnasal endoscopic approach to the infratemporal fossa for debridement of invasive fungal sinusitis. Methods Patients with invasive fungal sinusitis extending into the infratemporal fossa were treated with endoscopic debridement. Records of these patients were reviewed. Results Endoscopic debridement was performed in four patients with infratemporal fossa extension of invasive fungal sinusitis. Responsible organisms included Aspergillus, Mucor, and Candida. Adequate access and excellent visualization of the infratemporal fossa were obtained in all patients. The endoscopic anatomy and surgical technique are presented. Conclusion Endoscopic approaches have been used to manage a variety of disease processes that extend beyond the confines of the paranasal sinuses. Invasive fungal sinusitis disease with extension into the infratemporal fossa can be safely debrided via a transnasal endoscopic technique. The approach provides excellent visualization with low morbidity.

Relationship between septal body size and septal deviation.

Background Previous studies have described inferior turbinate hypertrophy compensatory to a septal deviation. The septal body contains vasoactive tissue that may behave in a manner similar to the inferior turbinate. The septal body, situated in the nasal valve region, may undergo changes that alter nasal anatomy and airflow patterns. The goal was to compare the size of the septal body to the laterality of septal deviation. The aim was to determine whether there is a correlation between the laterality of septal deviation and laterality of septal body prominence. Methods Measurements were obtained from 100 sinus computerized tomography scans that were retrospectively reviewed. The degree of septal deviation, the size of the septal body, and the correlation between these measurements were assessed. Results The mean septal body width was 9.3 mm. The degree of septal deviation was classified as mild in 27 cases, moderate in 36 cases, and severe in 27 cases. In 99 of 100 cases, the septal body was larger on the side opposite the nasal septal deviation, and this was statistically significant (p < 0.05). The difference in septal body thickness ipsilateral and contralateral to a septal deviation was found to correlate with the degree of septal deviation. Mean difference in septal body size was 3.98 mm in cases with severe septal deviation, 1.97 mm in cases with moderate deviation, and 1.21 mm in cases with mild septal deviation. Conclusion The septal body is more prominent contralateral to a septal deviation. These findings are similar to those seen with inferior turbinate hypertrophy. The results indicate that septal body hypertrophy may play a role in regulating nasal airflow and may contribute to nasal obstruction.

Frontolateral Hemilaryngectomy for the Management of a Case of Pediatric Squamous Cell Carcinoma of the Larynx

INTRODUCTION Squamous cell carcinoma is the most commonly reported epithelial malignancy of the pediatric larynx, but it is a very rare disease. Fewer than 60 cases have been reported. The clinical presentation and pathologic characteristics of the disease are similar to those of adults. As in adults, the glottis is the most commonly involved subsite. The same treatment options used for adults are available for the treatment of laryngeal malignancies in children. However, treating these tumors in pediatric patients is more challenging. The smaller size of the pediatric larynx makes surgical treatment more technically difficult. The risk of post treatment complications in children is greater and may be life-long, mandating careful consideration of all available treatment options. Reports of conservation laryngeal surgery for laryngeal carcinoma in pediatric patients are very rare. The case presented in this paper outlines the long-term outcome of a patient in whom a vertical partial laryngectomy was performed for glottic squamous cell carcinoma. In patients who are appropriate candidates, conservation laryngeal surgery can play a role for excellent oncologic and functional outcomes.

Early versus delayed treatment of primary epistaxis in the United States

Epistaxis treatment is variable. This study sought to determine demographic, management, and outcome differences in patients treated with early (<24 hours) vs late ligation or embolization.

Temperature variations of nasal endoscopes

Advances in light sources and endoscopes have improved illumination during endoscopic sinus surgery. However, these advances have also increased the temperatures the equipment reaches during the course of procedures. Limited data exist on temperature variations of nasal endoscopes and the potential risks of burns to drapes and patients. We attempt to quantify temperature variations of nasal endoscopes and light cords.

Comparison between three-dimensional and triplanar computed tomography imaging of the frontal recess.

Background Despite advances in endoscopic surgical techniques, management of frontal sinus disease remains challenging. Much of this is related to the complex nature of frontal recess anatomy. A thorough understanding of frontal recess anatomy is paramount for the safety and success of frontal sinus surgery. Three-dimensional (3D) computed tomography (CT) may allow surgeons to obtain a more complete preoperative assessment of frontal recess anatomy. The purpose of this study was to determine if reconstructed 3D CT images as an adjunct to conventional triplanar imaging provide additional information regarding the frontal recess anatomy. Methods A prospective study was performed. Two otolaryngologists reviewed the CT scans of 25 patients referred for routine paranasal sinus disease. The findings from review of the triplanar CT images were compared with the findings from review of the 3D reconstructions. Each study was assessed for (1) frontoethmoidal cells, (2) agger nasi cell, (3) subrabullar and frontal bullar cells, (4) intersinus septal cell, (5) superior uncinate process attachment site, and (6) and frontal sinus outflow tract. The examiners rated the usefulness of each study to identify each of the aforementioned anatomic subsites using a modified 5-point Likert scale. Results Intersinus septal cells, supraorbital ethmoid cells, and the anterior–posterior dimension of the frontal sinus outflow tract were better defined on the reconstructed 3D CT images. Conclusion Three-dimensional CT is a useful adjunct to the conventional triplanar studies for the evaluation of frontal sinus and recess anatomy. This technique can define certain anatomic variants more effectively than 2D multiplanar reconstructed images.