Oronasal fistula repair with three layers.

We present an innovative method for closure of oronasal fistulas involving a three-layer repair, consisting of septal mucosa flap, bone or cartilage graft, and palatal mucosa flap. The septal mucosa flap closes the nasal side of the defect. This is an inferiorly based flap along the nasal floor and consists of septal mucosa from the side opposite the oronasal fistula. A slit is created in the remaining layers of the nasal septum, allowing the flap to be delivered into the defect. When the septal flap is folded down in this fashion, it exposes nasal septal bone and cartilage. The bone and cartilage are harvested and are used to create the middle layer of the three-layer fistula repair. The oral layer of the repair is provided by a palatal mucosa transposition flap. This method allows the bone/cartilage graft to be sandwiched between two vascular layers. We have successfully used the three-layer repair on three patients. All of the oronasal defects were 2 cm in size. All patients are at least 1 year after repair with 100 percent closure; thus, no oronasal leakage. The flaps both septal and palatal resulted in no morbidity once healed. Specifically, the surgically created slit in the nasal septum is well mucosalized and barely discernible. Also, no nasal obstruction occurs from the septal flap on the floor of the nose. We perform the procedure on an outpatient basis. The three-layer repair can be used in adult patients with oronasal fistulas of the middle and posterior hard palate up to 3 cm in size. This technique is not recommended for children.

Septal replacement for severe anterior septal deviation.

PURPOSE: To introduce a novel surgical technique for treatment of severe anterior septal deviation. MATERIALS AND METHODS: Retrospective case series set in a tertiary-care hospital. Ten patients were treated over an 18-month period. External septorhinoplasty and septal replacement for severe anterior septal deviation. Postoperative clinical nasal examination and photographic comparison. RESULTS: Ten patients were treated with septal replacement for severe anterior septal deviation over an 18-month period. All patients were followed for a minimum of 1 year. No postoperative complications were seen. All patients reported a subjective improvement in their nasal airway and nasal appearance. This was confirmed with clinical examination and photographic comparison. CONCLUSION: Septal replacement for severe anterior septal deviation is a viable option for select patients who can not be successfully treated with conventional techniques.

Giant cell tumor of the larynx.

A case of giant cell tumor of the larynx is reported. Only two previous cases were reported in the English literature. A review of giant cell tumors is reported. The specific pathologic findings and treatment recommendations for this condition are discussed.

Submandibular rhabdomyoma.

A case of recurrent adult rhabdomyoma of the submandibular gland is presented. This is a rare tumor of the skeletal muscle. Approximately 80 cases have been reported. The salient pathologic features are reviewed and a discussion and review of the literature is presented.