Instruments and equipment for endoscopic sinus surgery.

It is the fiberoptic endoscope and its related hardware that distinguish endoscopic sinus surgery from previous techniques. Lens angles of 0, 25, and 70 degrees, comprising a representative telescope set, accommodate virtually any endoscopic sinus procedure, diagnostic or therapeutic, with unsurpassed visualization. Each telescope may be fitted with an optional suction-irrigation adaptor, a highly controversial accessory among endoscopic surgeons. The clinical situation often dictates the optimal combination of equipment, anesthesia, and technique; surgeon's preference is equally influential. Mastery of conventional operative techniques combined with thorough endoscopic skills is essential for consistent, effective, and safe surgical performance.

Implantation of a recurrent laryngeal nerve stimulator for the treatment of spastic dysphonia.

Spastic dysphonia, a rare speech disorder, is characterized by strained phonation with excessively adducted vocal cords. Recurrent laryngeal nerve section, botulinum toxin injection into the vocalis-thyroarytenoid muscle complex, and other techniques have been used to treat this disorder. We have used percutaneous electrical stimulation of the recurrent laryngeal nerve with good results. Previous dog studies demonstrated the relative safety of an implantable recurrent laryngeal nerve stimulator. In this study, we directly stimulated the recurrent laryngeal nerve and vagus nerve in a dog without change in cardiorespiratory status. A Medtronic peripheral nerve stimulator was implanted in a patient with abductor spastic dysphonia. The cuff electrode was positioned around the recurrent laryngeal nerve and stimulation resulted in improvement in her voice. Extensive cardiopulmonary monitoring did not reveal any adverse response to stimulation and there was no discomfort to the patient. On the basis of the good results of this preliminary study, further study with long-term follow-up is under way.

Experience with the sternocleidomastoid myoperiosteal flap for reconstruction of subglottic and tracheal defects: modification of technique and report of long-term results.

Subglottic or tracheal reconstruction may be required in cases of subglottic stenosis, invasive thyroid carcinoma, or trauma. The sternocleidomastoid myoperiosteal flap uses clavicular periosteum on a muscle pedicle to provide vascularity. Clavicular periosteum is fibrous, durable, and will conform to the shape of the trachea, forming bone to provide stability to the airway. The procedure is relatively simple and involves single-staged reconstruction. After 4 years' experience with this flap, we present the results from a series of 11 patients who underwent subglottic or tracheal reconstruction with the sternocleidomastoid myoperiosteal flap. Ten of 11 patients were successfully decannulated. The average time from reconstruction to decannulation was 50.3 days. Follow-up ranged from 12 to 40 months. We also describe modifications of the initial technique that have been introduced to improve the flap's versatility and effectiveness.

Thyroid carcinoma.

The mode of presentation, initial findings, treatment, and survival in differentiated thyroid carcinoma were studied in 155 patients. The classic signs, symptoms, and scan findings were present in approximately 70 per cent of the patients, with the remaining 30 per cent displaying unusual manifestations or findings. The effects of neck metastases, extracapsular invasion, and recurrent laryngeal nerve involvement on long-term survival were studied in detail. Prognosis was dependent more on age at initial appearance than any other factor. Patients with prior exposure to radiation had more extensive disease and required more extensive surgery, but they ultimately had the same prognosis for 10-year cure. Treatment of distant metastatic disease by surgery, radioactive iodine, and external radiation resulted in long-term survival in certain cases.

General techniques and clinical considerations in laryngologic laser surgery.

The carbon dioxide laser, one of the great advances in otolaryngology, has the characteristics of accuracy, reduced bleeding, reduced reaction, faster healing, and less scarring as compared with conventional surgery. Its beam is produced by creating an electric discharge within a cylinder containing carbon dioxide, nitrogen, and helium. The emitted beam is invisible, and special means are used to show exactly where the beam is going to impinge on the tissue. The effect of the power delivered to the tissue by the laser beam depends on the character of the tissues, the presence of char, the delivery device, and the condition of the lenses and mirrors. The imprint size varies with the power and the duration of exposure and is not necessarily the same as spot size. Repeated exposures increase the amount of tissue destruction and can be used to completely eradicate a lesion until the junction of normal and abnormal tissue is encountered. The following points and techniques are important in determining the results of carbon dioxide laser surgery. Increasing the power and reducing the duration of the beam result in less charring, less reaction, and faster healing. Overheating of tissues is avoided by using a skip technique. Char must be removed to prevent overheating of tissues and to aid in identifying accurately the junction of normal and pathologic tissues. Palpation may help identify pathologic tissue not readily apparent on inspection alone. The edge of the beam can be used to shave away pathologic tissue accurately while preserving normal tissues.(ABSTRACT TRUNCATED AT 250 WORDS)

Laryngeal amyloidosis and laryngocele.

Laryngeal amyloidosis and laryngoceles are uncommon. A unique case of both conditions occurring simultaneously is discussed. Preoperative computerized tomographic sections clearly demonstrated both disease processes, their extensiveness, and their intimate relation. These findings are correlated with the endoscopic and surgical findings. Gross and histopathologic specimens give full confirmation of the diagnosis. To our knowledge, this is the first case of laryngocele secondary to amyloidosis.

Nasopharyngeal lipoma.

Though lipoma is a common tumor in many anatomic sites throughout the body, its occurrence in the nasopharynx is extremely rare, with only several cases being reported in the literature. We describe a 17-year-old female with a nasopharyngeal lipoma. The mass had been present for at least 5 years and, despite its large size, was asymptomatic.