Stewart I. Adam

Laser versus stapler: outcomes in endoscopic repair of Zenker diverticulum.

To analyze a single surgeons experience with endoscopic CO2 laser and stapler repair of Zenker diverticulum (ZD) by comparing dysphagia and regurgitation outcomes.

Contemporary management of pediatric lateral sinus thrombosis: a twenty year review.

OBJECTIVES A case of pediatric otogenic lateral sinus thrombosis is reported, followed by a substantive literature review. DESIGN 104 patients were reviewed, culled from published case reports from 1993 to 2011 on the PubMed database. METHODS All full text case reports on the PubMed database from 1993 to 2011 with patients less than or equal to 16 years of age that outlined specific treatments were included. RESULTS 73% of patients were male and average age of presentation was 7.7 years. The most common symptoms were fever, headache, and otalgia, while the most common signs included otorrhea and neck stiffness. CT scans had a sensitivity of 87% and MR studies had a sensitivity of 100%. Single bacterial organisms were isolated in 46% of cases, with beta hemolytic streptococcus, streptococcus pneumoniae, and staphylococcus aureus being most common. Management included broad spectrum antibiotics (100%), mastoidectomy (94%), manipulation of the thrombosed sinus (50%), and anticoagulation (57%). The mortality rate was one in 104 patients. Morbidities occurred in 10% of patients and included cranial nerve palsy, sensorineural hearing loss, stroke, and septic hip joint. CONCLUSION Lateral sinus thrombosis is a rare but treatable complication of otologic disease in the pediatric population, warranting a high index of suspicion. Management should include broad spectrum antibiotics and surgical removal of all perisinus infection. Anticoagulation is not definitively associated with improved outcomes and warrants further investigation.

Esophageal perforation caused by edible foreign bodies: A systematic review of the literature

Presentation of a case of esophageal perforation caused by ingestion of a foreign body that was difficult to visualize endoscopically, and systematic review of the current literature with a focus on available diagnostic modalities and missed diagnoses.

Maxillary swing approach for extended infratemporal fossa tumors

INTRODUCTION Adequate surgical exposure is critical for removal of infratemporal fossa (ITF) tumors. Many surgical approaches, often combined, have been utilized to balance exposure with minimizing morbidity and damage to vital neurovascular structures. Wei et al. first demonstrated the usefulness of the maxillary swing in radical resection of nasopharyngeal and parapharyngeal space tumors. There has been a lack of agreement regarding the maxillary swing’s adequacy in approaching ITF tumors. We present three cases with successful application of the maxillary swing in resecting ITF tumors extending to the nasopharynx.

Endoscopic resection of an anterior skull-base Schwannoma.

Sinonasal Schwannomas represent less than 4% of all head and neck Schwannomas. These neural sheath tumors arise from the ophthalmic and maxillary divisions of the trigeminal nerve, as well as autonomic nerves from sympathetic fibers of the carotid plexus and parasympathetic fibers of the sphenopalatine ganglion. Patients commonly present with nonspecific symptoms such as nasal obstruction, epistaxis, and anosmia. Nasal endoscopy usually reveals a unilateral polypoid mass. Diagnostic imaging with computed tomography (CT) and magnetic resonance (MR) is typically nonspecific. Diagnosis may be delayed due to the masquerade of common sinonasal conditions, such as allergic rhinitis and chronic rhinosinusitis. We report a case involving a 51‐year‐old male with an anterior skull‐base Schwannoma that was excised endoscopically. Clinical features, imaging characteristics, histopathology, and treatment of sinonasal Schwannomas are discussed.

Use of intravenous immunoglobulin to treat chronic bilateral otomastoiditis in the setting of rituximab induced hypogammaglobulinemia.

The temporal bone may be affected by a variety of systemic pathology because the disease nature, location, and extent determine the symptoms. Middle ear and mastoid infections may be the initial clinical manifestation of autoimmune and acquired immunodeficiency disorders. Rituximab, an anti-CD20 chimeric antibody, has become increasingly popular as a therapeutic agent for patients with a wide range of autoimmune disorders refractory to standard treatments. Normal levels of immunoglobulin levels are usually maintained during and after rituximab therapy, and clinical trials to date have shown no statistically significant increase of serious infections among patients with autoimmune diseases being treated with rituximab (Cohen SB, Emery P, Greenwald MW, Dougados M, Furie RA, Genovese MC, et al, for the REFLEX Trial Group. Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy: results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial evaluating primary efficacy and safety at 24 weeks. Arthritis Rheum. 2006;54:2793-2806. Edwards JC, Szczepanski L, Szechinski J, Filipowicz-Sosnowska A, Emery P, Close DR, et al. Efficacy of B-cell-targeted therapy with rituximab in patients with rheumatoid arthritis. N Engl J Med. 2004;350:2572-2581). However, there have been several reports of opportunistic infections associated with rituximab (Kelesidis T, Daikos G, et al. Does rituximab increase the incidence of infectious complications? A narrative review. Int J Infect Dis 2011;15:e2-e16. Teichmann LL, Woenckhaus M, Vogel C, et al. Fatal Pneumocystis pneumonia following rituximab administration for rheumatoid arthritis. Rheumatology 2008;47:1256-1257), as well as cases of it accelerating the presentation of hypogammaglobulinemia (Diwakar L, Gorrie S, et al. Does rituximab aggravate pre-existing hypogammaglobulinaemia? J Clin Pathol 2010;63:275-277). Humoral immune defects can cause persistent acute and serous otitis media, with the development of chronic suppurative otitis media refractory to medical and surgical therapy (Sasaki CT, Askenase P, Dwyer J, et al. Chronic ear infection in the immunodeficient patient. Arch Otolaryngol 1981;107:82). Here, we describe the first presentation, diagnostic workup, and treatment with intravenous immunoglobulin of chronic bilateral otomastoiditis in the setting of rituximab-induced hypogammaglobulinemia.

Deep Plane Facelifting for Facial Rejuvenation

The purpose of this article is to provide the facial plastic surgeon with anatomical and embryologic evidence to support the use of the deep plane technique for optimal treatment of facial aging. A detailed description of the procedure is provided to allow safe and consistent performance. Insights into anatomical landmarks, technical nuances, and alternative approaches for facial variations are presented. The following points will be further elucidated in the article. The platysma muscle/submuscular aponeurotic system/galea are the continuous superficial cervical fascia encompassing the majority of facial fat, and this superficial soft tissue envelope is poorly anchored to the face. The deep cervical fascia binds the structural aspects of the face and covers the facial nerve and buccal fat pad. Facial aging is mainly due to gravitys long-term effects on the superficial soft tissue envelope, with more subtle effects on the deeper structural compartments. The deep plane is the embryologic cleavage plane between these fascial layers, and is the logical place for facial dissection. The deep plane allows access to the buccal fat pad for treatment of jowling. Soft tissue mobilization is maximized in deep plane dissections and requires careful hairline planning. Flap advancement creates tension only at the fascia level allowing natural, tension-free skin closure, and long-lasting outcomes. The deep plane advancement flap is well vascularized and resistant to complications.

Development, Anatomy, and Physiology of the Larynx

The human larynx, located at the crossroads of the upper digestive tract and tracheobronchial tree, has evolved structural and functional components to safely facilitate respiration, swallowing, airway protection, and vocalization. The larynx, trachea, and lungs begin formation at 28 days of life. Development continues into the neonatal period and through puberty, with cartilage maturation and larynx and hyoid decent. Detailed knowledge of the laryngeal cartilage skeleton and neurovascular structures is vital for both the head and neck surgeon and speech pathologist. A complex set of afferent and efferent pathways govern neuromuscular physiology, which dictate basic laryngeal functions through a delicate coordination of precisely organized brainstem reflexes. Significant work has been invested into understanding the unique and phylogenetically advanced protective, respiratory, and phonatory reflexes of the human larynx.