Otoplasty: critical review of clinical results

Although it is generally believed that otoplasty provides uniformly gratifying results, thorough patient follow-up reviews are quite rare. Otoplasty surgery performed on 119 ears was retrospectively reviewed to assess the results of our cartilage-sparing technique. This method of otoplasty relies on a conchal set-back and suture transfixation technique to improve the antihelical contour. Auricular medialization averaged 10.3 mm. Over-correction is required, particularly in the superior pole, as loss of correction with healing was approximately 40% of the initial medialization. Revision surgery due to loss of correction was necessary for 6.6% of the ears initially operated on by the senior author. Patients who presented following cartilage-cutting procedures tended to have a higher rate of revision and persistent postoperative stigmata. Complications in general were few; however, mersilene suture extrusion occurred in 8% of ears. Only one of these required revision surgery for associated loss of correction. Despite these drawbacks, over 95% of patients achieved satisfactory results using cartilage-sparing otoplasty techniques.     

Otoplasty: results of suturing and scoring techniques

In this study, we evaluated our otoplasty surgery results in patients with prominent ears. A total of 76 ears in 42 patients (20 male, 22 female; mean age 14; range 6–34 years) who underwent otoplasty surgery under general anesthesia between April 2005 and February 2012 were evaluated retrospectively. Of the 76 surgical cases, while 65 were operated on for the first time (primary), 6 had had previous unsuccessful surgical interventions at other institutes (secondary) and 5 were our own revision surgery cases. Of the primary cases; 11 had unilateral and 27 had bilateral surgery. Postoperative follow-ups were performed at week one, months one, three and six and at 1 year. While 60 of the 65 primary surgeries and all 6 of the secondary surgeries had successful results, 5 cases required revision surgery. The revision otoplasty surgeries were found to be successful in all patients on follow-up visits. Otoplasty surgery is an effective treatment method with high success rates for patients with prominent ears.     

Rhinomanometry: do the anterior and posterior methods give equivalent results?

Nasal resistance to airflow was measured by both anterior and posterior rhinomanometry in 15 healthy volunteers. It was found that the posterior method gave values on average 16% higher than the anterior method. This difference was statistically significant. We propose that this is due to posterior rhinomanometry measuring the resistance of the nasopharynx as well as the resistance of the nose. In the past a discrepancy between the 2 methods has been claimed to be due to an error in the standard form of the parallel resistance equation. This hypothesis was tested by measuring total nasal resistance by posterior rhinomanometry and comparing this with a total nasal resistance value derived from posterior rhinomanometric measurements of the resistance of the individual nasal cavities. The standard form of the parallel resistance formula was used to derive the total nasal resistance. There was no significant difference between the 2 values for total nasal resistance. We conclude that if measurements are made at the same pressure gradient then the use of this equation is valid.     

Otoplasty: results of a modified form of Mustardé's method

In order to investigate the results obtained after surgical treatment of prominent ears with a modified method basically derived from the technique of Mustardé 340 patients had been interrogated and 150 had been examined postoperatively. In 91.4% of the cases the patients themselves and in 84.7% the surgeon was satisfied by the postoperative result. Recurrence was observed in 17% and was due partly to the intermittent use of a resorbable suture material. In some cases recurrence consisted in a slight asymmetry, that was not really disturbing and did not need a further correction. A fundamental advantage of our surgical method is the fact that the cartilage has not to be destroyed, so that ugly and unnatural rims are avoided as well as some further postoperative complications (othematoma, perichondritis, pain and sensibility to the cold). Revision surgery even by another technique is always possible because the cartilage is left intact.     

Otoplasty: an update

Otoplasty is a common cosmetic surgical procedure. Various techniques have been described through the years, many of these addressing only specific aspects of the deformity rather than overall correction of the multiple defects that often occur. To achieve optimal results, an understanding of the embryology of the external ear and an appreciation of the development of otoplasty techniques are useful. Current surgical concepts are emphasized and the authors' graduated approach to otoplasty is presented. Thirty-five cases over a four-year period are reviewed. All achieved a satisfactory cosmetic result; there were 5 complications, 3 being due to Mustarde suture pull-away. Two of these required revision, and revision was also required in another patient who developed a hypertrophic scar. The remaining complication was a minor suture granuloma.     

鼻内镜下鼻泪管前径路和后径路切除上颌窦良性病变

目的 探讨鼻内镜下上颌窦内侧壁入路切除上颌窦良性病变的手术径路及手术方法的可行性及疗效.方法 2003年6月至2010年8月,采用鼻内镜下经鼻腔鼻泪管前径路和鼻泪管后径路的多种方式切除上颌窦良性病变139例,其中内翻性乳头状瘤43例、真菌性上颌窦炎63例、上颌窦囊肿28例、出血坏死性息肉3例、骨瘤2例.所有病例术前行CT检查,可疑内翻性乳头状瘤患者同步行MRI检查.鼻泪管前方径路采取3种方式:梨状孔入路、泪前隐窝入路(包括解剖鼻泪管和不解剖鼻泪管2种方式)、梨状孔鼻泪管人路,共治疗97例;鼻泪管后方径路也采取3种方式:下鼻甲翻转、双蒂下鼻甲、单蒂下鼻甲,共治疗42例.观察患者术后疗效.结果全部病例在鼻内镜下经鼻彻底清除病变,保护了鼻泪管,保留了下鼻甲,无一例发生鼻泪管损伤和下鼻甲坏死.术后鼻塞、头痛、闷胀不适、异味、牙疼和麻木感等症状逐步消失.9例感觉鼻腔干燥,经鼻腔冲洗等处理后1个月左右逐渐消失.随访6 ～79个月,骨瘤和出血坏死性息肉未见复发.所有真菌性上颌窦炎患者术中均可见窦腔黏膜明显水肿、增厚,术后3个月左右逐渐消失,无一例复发.2例上颌窦囊肿患者术后10个月和18个月在上颌窦其他部位再发,但囊肿小且无临床症状未作处理.内翻性乳头状瘤患者有3例复发,1例术后17个月上颌窦口上方局限性肿物突出,病理示乳头状瘤复发,门诊予以清理后随访1年未见复发;1例于术后15个月前筛处复发,行筛窦广泛切除后随访3年未见复发;1例术后26个月上颌窦后外侧壁局部复发,二次行蒂在前方单蒂下鼻甲方式手术,术后1年再次复发,行鼻内镜下Denker手术,随访18个月未见复发征象.所有病例术后3个月上颌窦创面上皮、瘢痕覆盖,下鼻甲形态良好,下鼻道开窗者较术中明显瘢痕变小,且引流通畅无闭锁.结论鼻内镜下鼻泪管前、后径路上颌窦手术可以减小创伤,充分暴露窦腔视野,并为术后内镜复查和复发后的处理提供了视窗;保留下鼻甲避免了鼻腔外侧壁去除过多而导致的术后干燥、结痂、头痛等并发症.     

Ex juvantibus approach for chronic posterior laryngitis: results of short-term pantoprazole therapy

The aim of this study was to investigate whether patients with chronic posterior laryngitis and symptoms of gastro-pharyngeal reflux benefit from a six-week therapy with pantoprozole. Twenty-nine out-patients with voice disorders (case history of at least two months) and simultaneous symptoms of gastro-pharyngeal reflux were recruited for this study. At the entry to the study a symptom questionnaire and a video-laryngo/stroboscopy were completed. The symptom questionnaire and the video-laryngo/stroboscopy were repeated after the six weeks of therapy with pantoprazole 40 mg once a day and again six weeks and three months after this follow-up, during which time the patient was without therapy. Hoarseness, globus pharyngeus, sore throat, heartburn, and coughing were the symptoms which showed a significant (p < 0.05) recovery at the follow-ups (mean of hoarseness index: 7.28 to 0.92; mean of globus pharyngeus index: 3.14 to 0.58; mean of heartburn index: 2.86 to 0.5; mean of cough index: 1.72 to 0.25; mean of throat soreness index: 1.72 to 0.15). Laryngoscopy scores of the posterior laryngeal region, the glottic and the supraglottic region showed statistically significant improvement (p < 0.05) after the treatment with pantoprazole. The therapeutic effect exceeded the drug administration until the last follow-up (after three months). The medication was tolerated without side-effects in all patients. A primary (ex juvantibus) therapy with proton pump inhibitors seems to be a therapeutic option for patients with long-lasting chronic inflammation of the larynx not responding to common therapy. In this case a six-week course of treatment has been shown to be sufficient.     

Long-term results after septal surgery--submucous resection versus septoplasty

Postoperative controls, 5-9 years after surgery, were made in two groups of patients who had undergone submucous septal resection and septoplasty, respectively. The rate of subjective improvement after septoplasty was higher (77%) than after septal resection (66%). In the septoplasty group, however, the experienced surgeons had an improvement rate of 90%, whereas the untrained surgeons had no better results than after submucous septal resection. Postoperative complications, including septal perforation and deformation of the external nose, were significantly fewer after septoplasty. There were no clear-cut correlations between rhinoscopy findings and subjective results at postoperative examinations. The septoplasty technique is advocated, but in the hands of a trained surgeon.     

A comparative analysis of anterior versus posterior squamous cell carcinoma of the tongue: a 10-year review

INTRODUCTION: The study sought to compare and contrast squamous cell carcinoma (SCC) of the anterior mobile tongue with SCC of the tongue base, with emphasis on clinical presentation, management and outcome. METHODS: This was a retrospective, comparative analysis of patients treated for SCC of the tongue over a 10-year period. Cox's regression model was used to assess the effect of tumour site on survival. RESULTS: The study included 142 patients, of whom 86 were treated for SCC of the anterior tongue and 56 for tongue base lesions. Patients with carcinoma of the anterior tongue tended to present with a visible lump or ulceration of the tongue, whereas the majority of patients with tongue base SCC presented with pain. Sixty per cent of anterior tongue lesions were early stage (I or II) at initial presentation as compared with 21 per cent of tongue base lesions. CONCLUSION: Patients with anterior tongue lesions had a better prognosis, but this was not statistically significant when adjusted for stage.     

Evaluation of the results of endoscope-assisted acoustic neuroma surgery through posterior fossa approach

The objective of this study was to evaluate the results of endoscope-assisted acoustic neuroma surgery in posterior fossa approach. Between 1996 and 2002, 60 consecutive patients with acoustic neuroma were operated via the retrosigmoid suboccipital approach. Standard 4-mm sinus endoscopes at different angles were used during the surgeries either for inspection or tumor endoscopic dissection. Clinical parameters and treatment outcome were evaluated retrospectively. Tumor sizes were small, medium and large in 46.6, 45 and 8.3% of the patients, respectively. The hearing preservation rate, which did not correlate with tumor size (p > 0.05), was 24.4%. The need for facial reanimation surgery, which was needed in 5% of patients, was significantly higher in the large tumors than in the small and medium tumors (p < 0.001). Cerebrospinal fluid fistula rate, which was not related to tumor size (p > 0.05), was 13.3%. Tumor recurrence or residual tumor was not encountered at all. In conclusion, endoscopes give accurate information about the relationship between the tumor and the adjacent structures and help control the fundus of the internal auditory canal to ensure complete tumor removal. It is also helpful in visually verifying the continuity of the facial and cochlear nerves. The use of endoscopes does not appear to increase the hearing preservation rate, but is very helpful in complete tumor removal in the posterior fossa approach.     

Risk factors and prognosis of anterior commissure versus posterior commissure T1-T2 glottic cancer

For better understanding of the causation and behavior of T1-T2 commissural glottic laryngeal tumors, we retrospectively analyzed risk factors and outcome related to T class and type of therapy for tumors involving the anterior (184 cases) or the posterior (60 cases) commissure. The patients' smoking habits and alcohol consumption were similar, regardless of involved subsite. The disease-free interval was longer after surgery than after radiotherapy. The survival rates after recovery upon relapse were similar among subsites, T classes, and types of therapy. In anterior commissure tumors, the larynx remained preserved more frequently after partial laryngeal resection than after radiotherapy, and was more frequently preserved the lower the T class. In posterior commissure tumors, larynx preservation was less frequent and apparently independent of type of therapy or T class. In conclusion, smoking and alcohol consumption play similar pathogenetic roles in either subsite; partial laryngeal resection gave a higher rate of laryngeal preservation than did radiotherapy; and anatomic peculiarities of the subsites influence tumor behavior.     

Functional results after experimental reinnervation of the posterior cricoarytenoid muscle in dogs

The purpose of the present investigation was to test and compare three different types of experimental posterior cricoarytenoid (PCA) muscle reinnervation. Dogs were subjected to reinnervation by the recurrent nerve itself (self-reinnervation) (n = 6), by the ansa cervicalis nerve (n = 5) or by the phrenic nerve (n = 5). In all but three of the self-reinnervation cases the adductor branch of the nerve was cut and ligated. Three to seven months postoperatively--depending upon the experimental approach--the animals were anesthetized and the function of the vocal cords was tested, visually evaluated and photographed. In the self--reinnervated larynges there were no observable movements on the reinnervated side during quiet inspiration, while during forced inspiration there were small but inconsistent movements. In the larynges reinnervated by the ansa cervicalis nerve no movements could be observed on the reinnervated side during either quiet or forced respiration. In four out of five larynges reinnervated by the phrenic nerve there were larger excursions on the reinnervated side as compared to the normal side during quiet respiration. During forced inspiration the excursions increased on both sides, but relatively more on the normal side. In all experiments indirect electrical stimulation gave large excursions on the experimental side indicating successful reinnervation. It is concluded that the phrenic nerve appears to be the best alternative if reinnervation of the PCA muscle in paralyzed larynges is attempted.     

Otoplasty: a review of the surgical techniques

? Otoplasty surgery carries a high satisfaction rate for participants (96%). ? Surgeons are more critical of the results of otoplasty than the participants or parents (92% satisfied). ? There is no statistical difference in qualitative results with different surgical techniques when comparing the published data. ? Data on otoplasty surgery is numerous, but quantitative assessment of surgical outcome is rare. ? The authors propose the measurement of cephaloauricular distance to allow comparison between studies.     

Indications and results of cauterization by endoscopic approach of the sphenopalatine artery in severe posterior epistaxis

OBJECTIVES: The authors present a retrospective study concerning cauterization by endoscopic approach of the sphenopalatine artery in the treatment of severe posterior epistaxis. The purpose is to evaluate the effectiveness of these therapeutics, their complications, to determine their indications and their contributions to the therapeutic arsenal of the treatment of severe epistaxis. PATIENTS AND METHOD: This study concerns 10 patients, which have been operated in the department of ORL head and neck surgery of Strasbourg and treated over a 23-month period (from January 2001 to November 2002), for clinically labelled posterior origin epistaxis. A preliminary treatment, by anterior and posterior tamponage, using a Brighton Epistaxis Balloon was carried out (n = 8); the use of an associated ligature of the ethmoidal arteries was sometimes necessary during operative time (n = 4). RESULTS: Hemorrhagic control with absence of recurrence was the rule (n = 9). A complementary interventional radiology embolization due to failure was necessary in one case. The average duration of post-surgical hospitalization was of 2.1 days. No post-surgical complications were noted. CONCLUSION: Cauterization by endonasal approach of the sphenopalatine artery in severe posterior epistaxis is a reliable intervention. Its role is clearly defined in our department, after failure of traditional treatments by packing methods.