Sanaz Harirchian

Efficacy of the pedicled nasoseptal flap without cerebrospinal fluid (CSF) diversion for repair of skull base defects: incidence of postoperative CSF leaks

The advances in endoscopic skull base surgery have led to the resection of increasingly larger cranial base lesions and the creation of larger skull base defects with the potential for increased postoperative high‐flow cerebrospinal fluid (CSF) leaks. These concerns led to the development of the vascularized pedicled nasoseptal flap (PNSF), which is now used as the mainstay for repair of large skull base defects in many academic centers. In this report, we review the incidence of postoperative CSF leaks in our institution in patients undergoing endoscopic skull base repair of high‐flow CSF leaks with a vascularized PNSF without concurrent CSF diversion.

Flexible fiber CO2 laser ablation of subglottic and tracheal stenosis

INTRODUCTION Acquired subglottic and tracheal stenosis is a challenging problem with many treatment options, including tracheostomy, endoscopic, and open surgical techniques. Treatment choice depends on the length, location, degree and quality of stenosis, cartilage integrity, and medical comorbidities. Although the main objective in the management of subglottic and tracheal stenosis is to provide a patent airway, other important secondary goals include avoidance of tracheotomy or early decannulation, and maintaining an adequate voice. Endoscopic laser ablation techniques have been described, including the neodymium-doped yttrium aluminum garnet (Nd:YAG) and microscope-mounted CO2 laser. The development of a flexible fiber CO2 laser delivery system allows for CO2 laser ablation of airway stenosis through a flexible bronchoscope. We present our experience with the CO2 laser via flexible bronchoscopy in two patients who were successfully managed with topical anesthesia and did not require tracheotomy.

Case report of a congenital lingual leiomyomatous hamartoma: new epidemiologic findings and a review of the literature.

We present an unusual case of a lingual leiomyomatous hamartoma, along with a current literature review of this previously under reported lesion. Described is a case of a 5 month-old male presenting with a posterior midline tongue mass and surgical excision yielded pathology consistent with a leiomyomatous hamartoma. A comprehensive literature review revealed thirty-nine cases of leiomyomatous hamartomas, a number much greater than previously reported. We conclude that these rare lesions are notably twice as common as previously reported and have equal gender predilection.

Safety of cranial fixation in endoscopic brow lifts

INTRODUCTION The endoscopic brow lift technique relies on brow mobilization and often soft fixation to the underlying calvarium. While the endoscopic brow lift has been used safely, there are anecdotal reports of cerebrospinal fluid leak. We sought to measure calvarial thickness to improve the safety of cranial fixation. METHODS A retrospective review was performed of T2 weighted MRIs of the face of 28 patients. Calvarial thickness was measured on 10 coronal planes, from 3 centimeters (cm) anterior to 6 cm posterior to coronal suture. Fifteen points were measured on each coronal plane, starting in the midline and extending laterally for 7 cm. There were a total of 150 calvarial measurements per patient, covering the surface area used in endoscopic brow lifts. Statistical comparison was performed using analysis of variance. RESULTS Cranial thickness ranged from 1.1 to 13.6mm, with a mean of 6.1mm. The skull was thickest 2-4 cm posterior to the coronal suture, and thinnest 1cm anterior to the coronal suture. The cranium thins as it extends laterally, with an average thickness of 5.0mm at seven centimeters from midline. Average skull thickness for males was 5.96 versus 6.16 in females. There was no relationship between age and skull thickness. CONCLUSION Cranial thickness increases medially and posteriorly, and is larger for females compared with their male counterparts. Given the risk of CSF leak, surgeons need to be aware of how cranial thickness varies by location along the skull.

Hemangiopericytoma of the larynx

Hemangiopericytomas are rare vascular neoplasms of the head and neck. Laryngeal involvement is even more rare, with only 9 previously reported cases in the literature. We present an unusual case of a 46 year old with a supraglottic hemangiopericytoma treated surgically. We will review the clinical features and treatment of hemangiopericytomas, as well as a review of the literature. Otolaryngologists need to be aware of this rare tumor that can be treated successfully with surgical resection. Close long-term follow up is needed since recurrence can present many years after initial treatment.

Use of AlloDerm in primary reconstruction after resection of squamous cell carcinoma of the lip and oral commissure

AlloDerm (LifeCell Corporation, Branchburg NJ) is an acellular dermal homograft processed from human cadaveric skin. AlloDerm has been used successfully for soft tissue reconstruction due to its lack of immunogenicity and minimal absorption. In the lip, it has been utilized for aesthetic lip augmentation and as an injectable filler. Description of its usage as an implant in primary lip reconstruction after tumor resection is limited. We describe the case of a 52 year old male with a squamous cell carcinoma of the oral commissure and lower lip. After resection, the defect was reconstructed using implanted AlloDerm for bulk, a buccal mucosal advancement flap, and a cheek rhomboid flap. Lip mobility and oral competence were normal 3 months postoperatively. The reconstruction achieved adequate augmentation without significant resorption. AlloDerm should be considered in primary lip reconstruction after cancer resection.

Complication of a columellar strut in an edentulous patient.

The cartilaginous columellar strut is a well established, commonly used graft in rhinoplasty which provides support and stability to the nasal base. The risk of such a graft is related to grafts designs, whereby the posterior aspect can cause clicking with movement across the anterior nasal spine. We present an additional unusual complication of ill-fitting maxillary dentures in an edentulous patient, previously not reported in the literature. This unique complication should alert facial plastic surgeons to use additional caution when sculpting columellar grafts in edentulous patients in order to avoid potential post-operative complications in this specific patient population.

Dual Time Point Positron Emission Tomography Imaging in the Head and Neck

Objective: Dual time point 18F-fluorodeoxyglucose-positron emission tomography (DTP-PET) is a new modality which may detect malignancy more accurately than standard PET/CT. Our main objective was to perform a pilot study to evaluate the characteristics of DTP-PET in primary head and neck squamous cell carcinomas (HNSCC) and lymph node metastases. Method: A total of 36 patients with previously untreated HNSCC underwent preoperative PET/CT at 2 time points (mean 41-minute time difference) from 2007 to 2010. Mean and maximum standardized uptake values (SUV) were measured for the primary lesion and cervical lymph node metastases at both time points, and change in SUV over time was calculated. Results: A total of 32 of 36 primary tumors (89%) had an increase in maximum SUV, between 13.93% and 264.65% (mean 43.7%) normalized to a 1-hour time difference. A total of 16 of 21 lymph node metastases (76%) had an increase in maximum SUV, between 13.49% and 284.15% (mean 57.1%). Change in mean SUV did not correlate as well with the presence of tumor. Conclusion: This is the first description of DTP-PET in HNSCC. A total of 89% of primary tumors showed an increase in maximum SUV over time. These findings justify further study of DTP-PET as a method of detecting tumor in initial staging and after treatment.