William D. Clark

Rhinoscleroma … a diagnostic challenge.

Rhinoscleroma is a rare chronic granulomatous infection predominantly affecting the upper respiratory tract. The patient presented here exemplifies several features of the disease, including the fact that diagnosis may elude the clinician for years, and this delay may increase morbidity substantially. The most common initial complaint is nasal obstruction, and physical examination frequently reveals erythematous granular or nodular swellings covered with crusts. Its tumor‐like appearance and local spread arouses suspicion of malignancy, but differential diagnosis also includes fungal infections and numerous granulomatous diseases. The classic histopathology consists of large vacuolated Mikulizs cells and transformed plasma cells with Russell bodies. Numerous antibiotics have been used for treatment of this infection with varying degrees of success. Long‐term follow‐up is important because these patients can have numerous relapses. Geographic distribution is also discussed.

Epithelial-Myoepithelial Carcinoma of the Parotid Gland

The EME carcinoma of intercalated duct origin is now recognized as a distinct salivary gland malignancy. A case has been reported that typifies clinical and pathologic features. Both the surgeon and pathologist should learn not only to recognize its dual cellular characteristics, but also to be aware of the potential destructive nature and possibility for metastases with this tumor.

Tumoral calcinosis in the neck

Tumoral calcinosis manifests soft-tissue calcification, usually near major joints. It variably includes hyperphosphatemia, elevated 1,25-dihydroxycalciferol, and an affected sibling. Serum calcium, alkaline phosphatase, and parathyroid hormone are normal. Tumoral calcinosis of the head and neck is very rare, but this diagnosis should be considered when x-ray film of a poorly defined mass shows irregular soft-tissue calcification.

Management of mandibular fractures

Fifteen years ago, writing an article with the title “Management of Mandibular Fractures” would have been a much easier task than it is today. Few areas of otolaryngology/head and neck surgery have experienced changes of the magnitude of those impacting on the management of maxillofacial trauma. A comprehensive review article on the subject of mandibular fractures will necessarily reflect the several biases of the author. As one with extensive experience in the successful application of conventional, prerigid fixation techniques to mandibular fractures, I was slow to accept the new hardware. Early published reports of results by surgeons in the United States documented complication rates that were unacceptable to me. I was confident that surgeons with limited traditional experience were too quick to adopt systems more exacting and unforgiving than those not yet mastered. In truth, I still believe that many of my fears and misgivings have basis in fact. Nevertheless, rigid internal fixation devices are here to stay and are now the treatment of choice for several types of mandibular fractures.

The Difficult Airway

M IN IS E M . tion. More recent innovations have been in the areas of electrosurgery, balloon dilatation, CT scanning (in-office, intraoperative), and paranasal sinus biomaterials. Further advances in powered instrumentation and image guidance have also continued to expand the boundaries of endoscopic sinus surgery. There are no currently established guidelines regarding when each of the available technologic innovations should be applied, although there is increasing clinical experience and evidence based data regarding how these modalities may expand the scope of rhinologic practice. This panel will present clinical and scientific data regarding the safety and efficacy of recent technologic innovations in the management of CRS. The potential roles for each of these modalities in both the operative and outpatient settings will be discussed. An evidence based algorithm for the application of each innovation will be presented. The panelists consist of experienced academic rhinologists and sinus surgeons who represent six academic tertiary centers. The panelist also lead in funded research for innovations to optimize the management of both basic and complicated sinonasal pathologies. EDUCATIONAL OBJECTIVES: 1) Recognize the variety of technological tools available in the management of patients with chronic rhinosinusitis (CRS). 2) Develop a rational algorithm for the application of these modalities in both the outpatient and operative setting. 3) Discuss the currently available clinical and scientific evidence for the safety, efficacy, risks and benefits of selected technologic innovations.

Mandibular Fractures—What to Do When

Educational objectives: To determine the appropriate techniques to treat a variety of mandible fractures and to access the special circumstances of the patient with a mandibular fracture and modify treatment accordingly.

Teaching Indirect Mirror Laryngoscopy

Indirect mirror laryngoscopy is difficult to learn. An anatomic model of the oropharynx and larynx is described here. This model is used to familiarize medical students with the component skills of mirror laryngoscopy. The students progress to competency at mirror laryngoscopy on patients more quickly after initial use of this model.

Otologic Medicine and Surgery

In a field in which books abound, there has long been a major void. While we have books dedicated to audiology and to anatomy, surgery, and even immunology of the ear, no recent undertaking has tackled the difficult task of putting all of the disciplines that deal with the ear and hearing under one title. Can we look to this two-volume set to fill the void? The editors are highly respected educators and practitioners of otolaryngology with strong otologic credentials. Europe and Australia are well represented among the 87 contributors. However, the North American contingency heavily favors Canada and New York, home base of the editors. The 73 chapters are organized in a logical sequence. The first nine deal with the basic sciences. The next 11 chapters are concerned with diagnosis. The third section covers pathology and pathophysiology in 14 chapters. Volume 2 dedicates its 38 chapters to therapy. Most