Comparison of L-strut preservation in endonasal and endoscopic septoplasty: a cadaveric study.

BACKGROUND: Preservation of an adequate cartilaginous L-strut to prevent complications of septoplasty has been long recognized as critical. However, no previous study has examined the dimensions of the L-strut that remain after septoplasty. We hypothesized that differences in exposure and visualization between endoscopic and endonasal techniques would result in differences in preserved L-strut dimensions. We designed this study to determine L-strut dimensions after performance of septoplasty with endonasal and endoscopic technique. METHODS: We performed a cadaveric study with 24 heads randomly assigned to undergo endonasal vs endoscopic septoplasty by senior resident surgeons (postgraduate year 4 [PGY-4] and PGY-5). Removal of the skin-soft tissue envelope and mucoperichondrium was performed after septoplasty to permit direct measurement of the L-strut. Minimum and maximum widths were recorded for the caudal and dorsal segments; a single measurement was recorded for the width at the anterior septal angle. Statistical analysis was carried out using the 2-tailed distribution Student t test. RESULTS: There was no significant difference in caudal or anterior septal width between endonasal and endoscopic techniques. There was a statistically significant difference in dorsal segment width for both minimum and maximum values, with endoscopic technique resulting in a narrower dorsal segment than endonasal technique (mean minimum value of 10.8 mm vs 13.2 mm, respectively, p = 0.03; and mean maximum value of 12.6 mm vs 16 mm, respectively, p = 0.01). There was significant variation in resident surgeon performance, with the performance of 1 resident surgeon accounting for the difference in minimum dorsal width. CONCLUSION: Differences in exposure and visualization between endoscopic and endonasal septoplasty techniques may result in differences in preserved L-strut dimensions. Care should be taken with endoscopic technique to prevent overly aggressive resection of septal cartilage, particularly with learners of this technique.

Role of ultrasound in thyroid disorders.

Thyroid ultrasonography has established itself as a popular and useful tool in the evaluation and management of thyroid disorders, both malignant and benign. Although its use has traditionally been the domain of radiologists, surgeons and endocrinologists are increasingly integrating this technology into their daily clinical and operative practice. This article provides an overview of the relevant uses and indications for ultrasound in various thyroid diseases, describes characteristic ultrasound findings in these diseases, and reviews the relevant literature and guidelines concerning its uses.

Limited utility of routine surveillance MRI following chemoradiation for advanced-stage oropharynx carcinoma.

Objectives. To determine the utility of routine surveillance MRI in detecting locoregional recurrence following definitive chemoradiation in advanced-stage oropharynx carcinoma. Methods. We identified patients with Stage III-IV oropharynx carcinoma who were treated with chemoradiation between April 2000 and September 2004 and underwent longitudinal followup care at our institution. Patient charts were retrospectively reviewed for findings on MRI surveillance imaging, clinical signs and symptoms, and recurrence. Results. Forty patients received a total of 229 surveillance MRI scans with a minimum follow-up of three years (mean of 5.6 scans per patient). Six patients experienced false-positive surveillance studies that resulted in intervention. Four patients experienced recurrent disease, two of whom had new symptoms or exam findings that preceded radiographic identification of disease. Surveillance MRI scans identified recurrent disease in two asymptomatic patients who were salvaged, one of whom remains free of disease at follow-up. The overall sensitivity and specificity of the MRI surveillance program were 50 and 83 percent, respectively. The mean charge to each patient for the surveillance program was approximately $10,000 annually. Conclusion. In oropharyngeal cancer patients who have been treated with chemoradiation, an imaging surveillance program utilizing MRI produces limited opportunity for successful salvage.