[show abstract][hide abstract] ABSTRACT: To review our technique of endoscopic transantral repair of orbital floor fractures.
Case series with chart review.
All orbital floor fractures treated with the outlined technique from 1998 to 2007 were reviewed in a retrospective fashion. Demographic data, surgical outcomes, and complications were gathered from available patient charts.
A total of 63 patients were treated with the described technique (44 male, 19 female). Thirty-nine patients underwent autograft placement from the anterior maxillary sinus wall harvest/exposure. Fourteen patients underwent placement of various alloplasts, and the remaining 10 patients underwent reduction of the contents and floor repositioning. Two patients underwent repeat repair due to inadequacy of initial repair. Both of these complications occurred in the subgroup of patients who underwent simple repositioning. There were no cases of blindness, permanent new diplopia, ectropion, entropion, or new infraorbital anesthesia.
The described technique of endoscopic repair of orbital floor fractures represents a precise method of fracture repair that results in excellent outcomes with minimal morbidity in the majority of patients. It allows for immediate fracture repair without the need to wait for periorbital edema to settle. It also allows for clear visualization of the entire fracture for precise graft placement.
Otolaryngology Head and Neck Surgery 07/2009; 140(6):849-54. · 1.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: We present the case report of a 95-year-old white female with a cutaneous T-cell lymphoma (CTCL) of the upper eyelid. Due to her comorbid medical problems, multidisciplinary tumor board recommendation for treatment was surgical excision. She underwent excision with frontalis muscle flap and contralateral eyelid full thickness skin graft reconstruction. The patient has been symptom free for 3.5 years. A literature review of cutaneous CTCL isolated to the eyelid is included.
[show abstract][hide abstract] ABSTRACT: Liposarcoma is the most common soft-tissue malignancy in adults, but the appearance of a liposarcoma in the head and neck region is distinctly unusual. Intraoral liposarcomas represent a particularly interesting subset of this tumor in that (1) they are exceedingly rare and (2) affected patients tend to have a better prognosis than do patients with a similar lesion located elsewhere in the head and neck. An understanding of the histologic subtypes and corresponding clinical behavior of liposarcomas will assist physicians in appropriately managing these patients. Most of these tumors can be effectively treated with conservative surgery. We report the rare case of a well-differentiated liposarcoma arising in the tongue of a 55-year-old man. We also discuss the typical pathologic findings in these malignancies and review the diagnosis, associated controversies, management, and prognosis.
[show abstract][hide abstract] ABSTRACT: T2-weighted fast-spin echo magnetic resonance imaging (MRI) can be an economically beneficial protocol for screening patients with asymmetric sensorineural hearing loss without other neurologic findings in a public hospital population.
The goal of this study was to determine if fast spin echo T2 MRI is similar to gadolinium-enhanced MRI in evaluating asymmetric sensorineural hearing loss in a county hospital population.
This was a retrospective chart review of all outpatients seen at a public hospital, comprising patients with no other cranial nerve findings who underwent gadolinium-enhanced MRI of the internal auditory canal and brain between January 2002 and September 2003. Patients with >15 dB difference in hearing at one frequency or 10 dB hearing difference at two frequencies underwent gadolinium-enhanced MRI scan with FSE T2 sequence as part of the examination protocol.
A total of 146 patients were identified who met all the inclusion criteria for the study. Of the 146 MRI scans performed, abnormalities were seen on 71 of them, the majority of which were inconsequential. No acoustic neuromas were identified in our study population. Cost savings of over 100,000 dollars would have been realized if only T2 FSE protocols had been used.
[show abstract][hide abstract] ABSTRACT: A sialoblastoma is a rare congenital epithelial tumor that arises in a major salivary gland. To our knowledge, only 24 cases of sialoblastoma have been previously reported in the English-language literature. We report a new case, that of a 15-month-old boy who presented with a submandibular mass. Surgical excision of the mass was undertaken. Intraoperatively, the mass appeared to be adjacent to the submandibular gland, but it had not invaded it. The mass was excised, and the submandibular gland was left in place. Pathology identified the tumor as a sialoblastoma. However, pathology also revealed that residual tumor was present at the surgical margin. The patient was returned to the operating room for excision of the left submandibular gland and the level I lymph nodes. Following revision surgery, the surgical margins were negative. The patient remained disease-free at the 1-year follow-up. Despite the need for revision surgery, this case provides support for the idea that surgery alone is sufficient for curative treatment.
[show abstract][hide abstract] ABSTRACT: To review our experience with patients diagnosed with giant myxomas of the maxillofacial skeleton.
All patients undergoing excision of myxomas of the head and neck from September 1998 through September 2003 with a minimum follow-up of 1 year by the senior author (YD) were included in the study.
A retrospective chart review was conducted to select all patients who met the inclusion criteria. Clinical presentation, preoperative radiology findings, excisions performed, reconstruction, and follow-up were recorded and reported.
Four patients were identified who met the inclusion criteria. All underwent wide en bloc excision of the tumor with various reconstructions. Complete resection was achieved in each case, and no patients have had evidence of recurrence.
Giant myxomas of the maxillofacial skeleton have been reported to have significant rates of recurrence. Wide en bloc resection with appropriate reconstruction can result in excellent quality of life postoperatively and minimize the risk of recurrence. Lesser resections may not be appropriate especially in giant myxomas because of the potential morbidity that would be associated with a multifocal recurrence.
Otolaryngology Head and Neck Surgery 07/2006; 134(6):931-5. · 1.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate the long-term efficacy of hydroxyapatite cement in craniofacial reconstruction, specifically examining the role (if any) of radiation, implant location, and cement type.
A retrospective chart review was conducted of all patients presenting to the senior surgeon (Y.D.) for craniofacial reconstruction from September 1997 to April 2004.
Data were collected including type of cement used, size of defect, complications, need for removal of cement, reason for defect, and pathologic results of examination of removed cements.
One hundred two patients were identified who underwent craniofacial reconstruction with hydroxyapatite cements, 7 of whom required complete implant removal (6 Norian and 1 Mimix), and 4 (2 Norian and 2 Bone source) of whom required partial implant removal for foreign body reaction. Five of the removals were in patients who underwent postoperative radiation.
Hydroxyapatite cements are safe in craniofacial reconstruction. The highest risk of implant infection comes from reconstruction in the area of the frontal sinus, immediately beneath coronal incisions, and in patients who receive postoperative radiation treatment. Based on our results, there does appear to be a statistically significant difference in rates of infection and foreign body reaction between the different types of hydroxyapatite cement. We would not recommend implantation of this material in contact with the frontal sinus. Caution should be exercised when it is placed directly beneath an incision or in patients receiving postoperative radiation, particularly if a boost dose is given.
Otolaryngology Head and Neck Surgery 01/2006; 133(6):897-9. · 1.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: We report the identification of a kaposiform hemangioendothelioma (KH) in the oropharynx of a 3-year-old boy. This is a rare endothelial-derived spindle cell neoplasm affecting children and early adolescents with features common to capillary hemangioma and Kaposi sarcoma. Nine cases of head and neck KH have been reported, this being the first in the otolaryngology literature. Our patient underwent wide local excision and has remained tumor free for over 1 year. KH should be considered in the differential diagnosis of a vascular lesion demonstrating unexpected behavior from that of a hemangioma.
The Laryngoscope 11/2005; 115(10):1789-92. · 1.98 Impact Factor
[show abstract][hide abstract] ABSTRACT: Extracranial internal carotid artery aneurysms are very uncommon entities. We present the case of a young girl who was transferred to our institution after development of a neck mass after Quincy tonsillectomy. The literature on extracranial carotid artery aneurysms is reviewed and reported.
International Journal of Pediatric Otorhinolaryngology 09/2005; 69(8):1135-9. · 1.35 Impact Factor
[show abstract][hide abstract] ABSTRACT: This review was conducted to examine current evidence focusing on the effect of nasal steroid sprays on nasal ciliary function.
Review of current literature suggests that long term effects of topical corticosteroid nasal sprays are safe and fail to cause damage to local nasal structure and function.
The use of corticosteroid nasal sprays for the treatment of allergic rhinitis is widely accepted. Popularity of this class of medications is based on a well-established combination of efficacy, tolerability, and safety. Although current literature suggests that the use of intranasal steroids is indeed safe, increasing indications for prolonged administration continue to fuel debate regarding the long-term effect on local nasal structure and function. The purpose of this article is to review current literature addressing the effects of the components of local intranasal steroid sprays on the structure and function of the nasal mucosa.
Current Opinion in Otolaryngology & Head and Neck Surgery 03/2005; 13(1):14-8. · 1.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate the effectiveness of endoscopic cauterization as definitive treatment for fourth branchial cleft sinuses.
Retrospective chart review with follow-up questionnaire.
Tertiary care children's hospital.
Ten children (age range, 10 months to 10 years) with fourth branchial cleft sinuses treated with endoscopic cauterization between 1995 and 2002.
Recurrence of neck infections after endoscopic cauterization of fourth brachial cleft sinus tracts.
Seven of the 10 patients treated with endoscopic cauterization of the fourth branchial cleft sinuses showed no recurrence with an average follow-up of 3 years. Three of the patients were unavailable for follow-up, but medical records of the hospital showed no additional admissions for those patients for neck masses. No morbidity of the procedure was identified. All patients were discharged the day of surgery.
Endoscopic cauterization of fourth branchial cleft sinuses appears to be an effective alternative to open excision.
Archives of Otolaryngology - Head and Neck Surgery 05/2004; 130(4):465-8. · 1.78 Impact Factor