Raymond O. Smith

Medial conchal excision in otoplasty

The most common cartilaginous deformities in protruding ears include an inadequate antihelical fold and an enlarged concha. We have employed medial conchal excision to correct deep conchas in 25 patients, all of whom were pleased with the postoperative result. Obvious wrinkling of the anterior skin occurred in four patients, and several patients displayed slight distortion of the helical crus. Medial conchal excision does not impede management of the antihelical fold with mattress sutures or by other means. We consider the risk of minor alterations of the concha justified if even slight distortion of the more conspicuous lateral auricle can be avoided.

Tonsillar Carcinoma in the Contralateral Tonsil

OBJECTIVE We report a series of patients treated for carcinoma of the tonsil who either presented with bilateral carcinomas or later developed a second primary carcinoma of the contralateral tonsil. This report raises awareness of this occurrence. STUDY DESIGN Case series. METHODS Four cases have been identified of either concomitant or subsequent carcinoma of the contralateral tonsil inpatients treated for tonsillar carcinoma from the practices of 3 head and neck surgeons in a single demographic area over a 35 year span. RESULTS Four patients were identified who were treated for tonsillar carcinoma with concomitant or subsequent carcinoma of the contralateral tonsil: One patient with bilateral metastatic carcinoma in cervical lymph nodes was found to have bilateral occult tonsillar primaries.Three patients who were treated for tonsillar primary carcinomas subsequently developed carcinoma of the contralateral tonsil. CONCLUSIONS A small population of patients with unilateral tonsil carcinoma will developed a second in the contralateral tonsil. This raises the question of whether removal of the contralateral tonsil at the time of initial treatment might have spared the morbidity/mortality of the subsequent contralateral tonsil cancer.

Herpes zoster oticus. Uncommon but recognizable cause of facial paralysis.

Three cases of herpes zoster oticus illustrate the manifestations of this relatively uncommon cause of facial paralysis. Topographic analysis, in which functions of facial nerve branches are assessed, helps establish the level of facial nerve involvement. Sequential faradic stimulation testing often is a sensitive prognostic indicator of recovrey of facial nerve function, particularly if nerve excitability persists. A few recent reports support the use of systemic steroid therapy for herpes zoster oticus; opinions vary regarding the efficacy of surgical decompression for facial paralysis. Although general principles cannot be deduced from three cases, each case discussed exemplifies an important aspect of management. The prognostic significance of results of nerve stimulation tests is illustrated by the complete return of facial nerve function in our first patient. Our second patients response to systemic steroid therapy supports recent reports of the value of such agents in herpes zoster oticus. Partial return of facial nerve function in our third patient two months after onset of paralysis accentuates the importance of a period of observation before a nerve graft or other rehabilitative procedures are undertaken.

Treating acute otitis media. 2.

When a child with otitis media has severe pain, fails to respond to antibiotics, shows a persistent conductive hearing loss, or has other apparent or impending complications, the physician should usually perform a myringotomy. Properly done, the procedure carries little risk, but the physician should follow the patient closely until the ear drum looks normal.