William O. Collins

Complications of mandibular fractures

Timely repair of mandibular fractures remains an effective means to reduce pain, restore function, and prevent complications. This study addresses the effect of the time interval between injury and treatment on the overall complication rate, the complication rate between various treatment modalities (mandibular-maxillary fixation [MMF] alone, MMF with intraosseous wire bone fixation, and MMF with rigid internal fixation), and the relationship of inpatient vs. outpatient management. Cost was also examined with respect to choice of management. We report a retrospective series of 308 consecutive patients managed at the University of Miami/Jackson Memorial Hospital. Patients who received treatment 3 to 10 days following injury were found to have a lower complication rate than earlier or later repair. We postulate that most patients with mandibular fractures may be managed on an outpatient basis, which represents a considerable savings in cost.Moulton-Barrett R, Rubinstein AJ, Salzhauer MA, Brown M, Angulo J, Alster C, Collins W, Kline S, Davis C, Thaller SR. Complications of mandibular fractures.

Long-term effect of stenting after an endoscopic modified Lothrop procedure.

Background The aim of this study was to study the effect of stenting with a silastic sheet on the long-term patency of the common frontal ostium after an endoscopic modified Lothrop procedure (EMLP). Methods A retrospective analysis was performed of prospectively collected data at an academic tertiary referral center, where 72 patients underwent an EMLP between 1996 and 2003. Patency of the common frontal ostium was studied as an ordinal variable with three classes (patent, stenotic, and closed). Results A common ostium was endoscopically visualized in 94% of the patients (61.1% patent and 33.3% stenotic). Symptoms improved in 75% of the patients. A significant positive correlation was found between ostium patency and symptom improvement. Twenty-five patients were stented postoperatively. There was no statistical difference between the stented and the nonstented groups with regards to ostium patency and symptoms improvement. Conclusion Short-term stenting does not appear to reduce the rate of postoperative stenosis of the common frontal ostium after an EMLP.

Extramedullary hematopoiesis of the paranasal sinuses in sickle cell disease.

S ickle cell disease is one of the most common hemoglobinopathies, affecting primarily African Americans. It results from a genetic substitution in the beta-chain of hemoglobin. Clinical manifestations occur as a result of vascular clogging due to changes in erythrocyte shape. As a result of the chronic anemia associated with homozygous sickle cell disease, extramedullary hematopoiesis has been known to arise in these patients throughout the body. We present an unusual case involving the paranasal sinuses, which provided both diagnostic and treatment challenges. To the best of our knowledge and review of the English literature, this is the second case of maxillary sinus extramedullary hematopoiesis in sickle cell disease.

A review of reprocessing techniques of flexible nasopharyngoscopes

To provide assistance to otolaryngologists to decide the best manner in which to reprocess flexible nasopharyngoscopes, a review of existing English language medical literature regarding the methods of flexible endoscope reprocessing was performed, including previously published guidelines from other medical disciplines. Multiple steps were confirmed to be critical to effectively reprocess flexible nasopharyngoscopes. High-level disinfection has been determined to be the minimum level of disinfection required for reprocessing of flexible nasopharyngoscopes. Several steps are important in all reprocessing techniques, including manual cleaning, leak testing, cleaning with an enzymatic agent, high-level disinfection, and drying with vertical storage. Three techniques are available to achieve high-level disinfection: manual disinfection with a liquid disinfectant/sterilant, use of an automated endoscope reprocessor, and use of a disposable sheath. Achieving high-level disinfection of flexible nasopharyngoscopes can be accomplished by a variety of methods. Strict adherence to recommended procedures is critical.

Bilateral semicircular canal aplasia: A characteristic of the CHARGE association

Congenital inner ear malformations have been well described in the literature, with malformations reported in the cochlea, vestibular labyrinth, vestibular aqueduct, and internal auditory canal. Although semicircular canal (SCC) dysplasias are often accompanied by cochlear malformations, isolated cases of SCC aplasia have also been described (1). A 9-year-old girl was recently evaluated at our institution for hearing loss and a left congenital facial paralysis. Figure 1 shows high-resolution computed tomography (CT) scans of her temporal bones that revealed middle and inner ear anomalies as well as bilateral facial nerve dysmorphology. Specifically, the ossicles showed hypoplastic incus bones as well as fusion of the malleus head to the anterior epitympanic wall. Although the cochlea and vestibule development appeared normal, there was complete bilateral SCC aplasia. The first genu of the facial nerve also lacked the acute angulation normally seen between the labyrinthine and tympanic segments. Rather, a gentle posterior curve of the nerve was present in the geniculate ganglion region. The CHARGE mnemonic was originally proposed to explain an association of findings (C, coloboma; H, heart disease; A, atresia choanae; R, retarded growth and development; G, genital hypoplasia; E, ear anomalies) in a certain subset of patients (2). Since then, numerous groups have attempted to further describe the findings that characterize this association. Otologic abnormalities within the CHARGE association are among the most consistent findings, involving the external, middle, and inner ear. Using CT imaging, Dhooge et al demonstrated ossicular fixation resulting from fusion of the malleus head to the anterior tympanic wall in 100% of ears (n 14) examined. Moreover, 12 of 14 ears also had evidence of incus abnormalities, and all had abnormal stapes (3). These findings were quite similar to those described in our case. Other authors have shown CHARGE patients to have a single, fused ossicular mass (4). The inner ear is not immune to malformations associated with the CHARGE syndrome. Both cochlear and semicircular canal malformations have been identified, with vestibular labyrinthine defects being more common. The SCCs have been identified as either hypoplastic or, more commonly, completely aplastic in 50% to 100% of cases (3,5). Cochlear malformations, such as Mondini’s deformity, have also been seen in association with the SCC defects. The particular combination of a hypoplastic incus and SCC dysplasia was seen in 44% of patients in one study, leading its authors to call this “characteristic of the CHARGE association” (4). A facial palsy or paralysis was also identified in 36% to 56% of reported patients (4,5). Abnormal facial canals were identified in 57% of temporal bone CT scans (3). To our knowledge, no association has been identified between the clinical presence of a facial palsy and abnormal facial nerve morphology by CT scan.

Correlation of mucociliary clearance and symptomatology before and after adenoidectomy in children.

OBJECTIVE The goal of this study is to better understand the role of adenoid hypertrophy and its impact on mucociliary clearance as it relates to the symptoms of chronic sinusitis in children. More specifically, the goal is to better understand which symptoms of chronic rhinosinusitis might be most likely to improve in children undergoing an adenoidectomy. METHODS We conducted this study on 35 healthy children (>3 and <18 years of age), either male or female, who underwent adenotonsillectomy or adenoidectomy (with or without tympanostomy tube insertion). Eighteen patients completed pre- and postoperative surveys, with 10 also completing the Andersens saccharine test (AST). The nasal mucociliary clearance will be evaluated with the AST, in which a saccharin particle (1.5mm diameter) is carefully placed on the floor of the nasal cavity approximately 1cm behind the anterior end of the inferior turbinate. The time taken by the subjects from placement of particle to the perception of the sweet taste will be taken as mucociliary clearance time (MCT). The length of the nasal cavity is measured intraoperatively as the distance between the upper medial incisor and the inferior edge of the soft palate. From these two values nasal mucociliary clearance velocity (MCV) (cm/min) can be calculated and assessed. This study took place at an academic institution. RESULTS Symptomatic improvement was seen in all categories, as measured by the mean score improvement postoperatively. The greatest improvements were seen in nasal obstruction (mean=2.67 points ± .59) on the symptom survey, and emotional distress (mean=2.56 ± .47) on the SN5 survey. Quality of life improved by a mean=2.61 ± .49. Both MCT and MCV improved postoperatively (mean 3.64 min ± .84 and mean 1.96 cm/min ±.90, respectively). CONCLUSIONS We believe this study has the potential to provide otolaryngologists across the country with a benchmark to communicate the specific symptomatic benefits from adenoidectomy.

The Effects of Balloon Dilation Laryngoplasty in Children With Congenital Heart Disease

OBJECTIVE To determine the utility of performing balloon dilation laryngoplasty of subglottic stenosis (SGS) in children with underlying congenital heart disease (CHD). DESIGN Retrospective study. SETTING Tertiary care academic health center. PATIENTS Children with an underlying diagnosis of CHD who subsequently underwent balloon dilation laryngoplasty for SGS from January 1, 2006, through December 31, 2011. MAIN OUTCOME MEASURES Clinical improvement and avoidance of tracheotomy. RESULTS We identified 16 children who had a diagnosis of CHD and underwent direct laryngoscopy and bronchoscopy. Five patients (3 girls and 2 boys) underwent a total of 11 balloon dilations for SGS. Their ages at initial dilation ranged from 1 to 4 months. All 5 patients had grade III SGS. Only 1 patient required a salvage tracheotomy for a thick glottic web and associated SGS after her first balloon dilation failed to improve airway patency. The remaining 4 patients have had long-term success in avoiding tracheotomy with symptomatic improvement. CONCLUSIONS Balloon dilation represents a valuable treatment option in patients with CHD and SGS in whom a tracheostomy should be avoided.

Microdebrider resection of bilateral subglottic cysts in a pre-term infant: a novel approach.

Acquired subglottic cysts are a rare cause of stridor in infants. The two major risk factors for development of these cysts are prematurity and history of intubation. Microlaryngeal decompression and carbon dioxide laser resection of these cysts have been the most common treatment methods with recurrence rates as high as 43% [J. Lim, W. Hellier, J. Harcourt, S. Leighton, D. Albert, Subglottic cysts: the Great Ormond Street experience, Int. J. Pediatr. Otorhinolaryngol. 67 (2003) 461-465]. Carbon dioxide laser therapy also carries the risk of airway fire, injury to adjacent structures, and possible delayed scarring. We present a case of bilateral subglottic cysts in a premature infant with progressive stridor, treated using a microdebrider, and review the literature regarding the treatment of these lesions.

A comparison of two methods of endoscopic dilation of acute subglottic stenosis using a ferret model

Balloon dilation is accepted as a first line treatment of acute subglottic stenosis, but its effects on the subglottic tissue remain largely unknown. We aimed to develop an animal model of acute subglottic stenosis using endoscopic techniques. Once developed, this model was used to compare the immediate effects of balloon dilation and endotracheal tube dilation on subglottic tissue.

Persistent Foramen of Huschke Mimicking a Branchial Cleft Anomaly

Apersistent foramen of Huschke, or foramen tympanicum, results from the defective ossification of the anteroinferior aspect of the tympanic portion of the temporal bone. We describe 2 girls, aged 5 and 6 years, with histories of recurrent cervical abscesses, draining submandibular sinuses, and defective tympanic plates adjacent to the tympanic ring. Surgical resection of the fistulous tract extending from the submandibular triangle to the bony ear canal successfully controlled the symptoms.