Ritvik P. Mehta

What's New in Skull Base Medicine and Surgery? Skull Base Committee Report

Skull base surgery is a young subspecialty within otolaryngology-head and neck surgery and neurosurgery. Although collaborative medical and surgical efforts directed at both the intracranial and the extracranial aspects of the bony skull base had been carried out throughout the 20th century, the term skull base surgery was introduced only in the late 1960s and early 1970s. The 17-year-old North American Skull Base Society is probably the youngest subspecialty society in otolaryngology-head and neck surgery. Similarly, the Committee on Skull Base Surgery was established within the American Academy of Otolaryngology-Head and Neck Surgery to address academic, professional and clinical needs of Academy members as they treat patients with skull base pathology. It is through collaborative work of this committee that this review article has been conceived and written. The initial enthusiasm that accompanied heroic surgical procedures now needs to be followed with careful assessment of effectiveness, complications, and outcome. That is why we emphasize outcome studies in this publication. With advancements in imaging, diagnostic technology, diagnostic pathology, surgical technology and instrumentation, reconstructive techniques, and rehabilitation, the subspecialty of skull base medicine and surgery is now receiving significant attention and interest. It is the purpose of this publication to provide our readers with an overall review of “the state of the subspecialty.”

Pediatric deaths due to otolaryngologic causes : A population-based study in Massachusetts, 1990-2002

Objective: To identify the most common otolaryngologic causes of mortality in the 0 to 19 age group in the state of Massachusetts and to estimate the pediatric otolaryngologic mortality rate based on population data.

P075: Osteoma of the Larynx: A Case Report

OBJECTIVES: 1. To present the second reported case of an osteoma of the larynx. 2. To review the pertinent literature on bony lesions of the larynx. METHODS: Case report and review of the literature. RESULTS: The team presents the case of a 48-year-old man who presented for evaluation of worsening dysphonia and dysphagia over one year. He had limited exercise tolerance secondary to dyspnea and had symptoms of aspiration with thin liquids. On flexible fiberoptic laryngoscopy, a mass was seen spanning the interarytenoid region and causing impairment of vocal fold mobility with a persistent glottic gap. On operative microlaryngoscopy, a firm calcified mass was encountered in the interarytenoid region. This was essentially chiseled out using laryngeal instruments. The patient’s vocal fold mobility was normal on his postoperative evaluation. His dysphonia and dysphagia resolved completely. Histopathologic evaluation revealed lamellar cortical and trabecular bone with a fatty and hematopoietic marrow consistent with an osteoma. This case represents the second reported case of a laryngeal osteoma. Bony tumors of the larynx are extremely rare. Typically, osteomas are firm, nodular masses of bone. Histologically, they are characterized by trabeculae of lamellar bone. A fibrofatty marrow space may be seen. Radiographically, they appear as well-defined calcific masses. The etiology of osteomas is unknown although trauma and infection have been proposed as inciting factors. The primary therapy for symptomatic osteomas is surgical excision. CONCLUSIONS: Osteomas of the larynx are extremely rare but can cause significant functional impairment. Surgical excision is the mainstay of therapy for these rare lesions.

08:28: Novel 3-D Video for Quantification of Facial Movement

during microvascular free tissue transfer surgery. 2. Compare the incidence of flap complications and survival in patients who received vasopressors and those who did not. METHODS: Retrospective chart review in a tertiary academic center. Study subjects consisted of all microvascular free tissue transfers performed between 2004 and 2005. RESULTS: Of 92 free tissue transfers performed, 89 had data available for analysis; 76 flaps were performed for reconstruction after cancer surgery and 13 for trauma, failed flaps or other complex wounds. Flap survival was 92%, with seven total losses and 21 other complications including hematoma formation, wound infection, fistula development, arterial and venous thrombus formation requiring flap revision, and partial flap loss. Seventy-four (83%) patients received vasopressors intraoperatively. Of these, 3 (4%) total flap losses and 18 (24%) minor complications occurred. All losses were secondary to vascular pedicle thromboses. Fifteen (17%) did not receive intraoperative vasopressors. Of these, 4 (27%) total flap losses and 3 (20%) minor complications were noted. Two losses were secondary to internal jugular vein thrombosis, one of which occurred in an infected wound; the remaining two were secondary to vascular pedicle thromboses. CONCLUSIONS: Vasopressor use in free flap surgery occurs commonly and is likely not as harmful as previously thought.