Thyroid cartilage fracture repair in rabbits: comparing healing with wire and miniplate fixation.

OBJECTIVES: Evaluate cartilaginous healing in rabbits in response to surgically created thyroid cartilage fractures. Compare healing between laryngeal fracture repair techniques. STUDY DESIGN: Animal model. MATERIALS AND METHODS: Laryngectomy specimens were analyzed at 10 weeks, following paired wire fixation (n = 7) and miniplate fixation (n = 7) of thyroid cartilage fractures. RESULTS: Cartilaginous unions were present in all seven of the miniplated repairs, while fibrous unions were present in six of the wired repairs. The measure of distraction at the fracture site was significantly greater in the wired repairs compared with the plated repairs (P = .005). Furthermore, in five of seven miniplated repairs no distraction at the healed fracture site was present. CONCLUSIONS: The results demonstrate the ease, tolerability, and superiority of the miniplate fixation technique for the thyroid cartilage fractures, based on a rabbit model.

The comparative strength of laryngeal fracture fixation.

PURPOSE: To assess the fixation strength provided by miniplate fixation, wire-tube batten fixation, and wire fixation alone in repair of thyroid cartilage. MATERIALS AND METHODS: Segments 2.5-cm wide x 1-cm long were cut from three fresh, frozen, human cadaveric larynges from an 83-year-old man, a 58-year-old woman, and an unknown cadaver. A vertical fracture was induced and repaired with one of three randomly assigned fixation techniques (n=10 in each fixation group). The repaired cartilage was placed in an Instron Universal Testing Device (Boston, MA) and subjected to a three-point bending test. Load to failure was recorded on an analogue graph. RESULTS: All reconstruction techniques significantly differed from each other, with miniplate fixation providing a stronger repair than wire tube batten (P < .05), wire tube batten providing a stronger repair than wire alone (P < .01), and miniplate providing a stronger repair than wire alone (P < .001). CONCLUSION: In experimentally induced fractures of the human larynx, miniplate fixation consistently yielded the strongest repair. Although both miniplate and wire batten produced excellent anatomic reaction, we feel that miniplate fixation was easier to perform.

Pullout strength of adaption screws in thyroid cartilage.

PURPOSE: To determine the pullout strength of adaption screws in laryngeal cartilage and its relationship to drill hole and screw diameter. MATERIALS AND METHODS: Screw pullout strength in human cadaver thyroid cartilage was measured using a load cell. Screw sizes of 1.3, 1.5, and 2.0 mm were tested using drill hole diameters of 0.76, 1.1, and 1.5 mm. RESULTS: Maximum pullout strength was achieved using a drill hole diameter of 0.76 mm and a 1.5 mm screw. Pullout strength for this combination was 27.5 N. CONCLUSION: Adaption screws can be used in thyroid cartilage but pullout strengths will be less than in bone. Drill holes for screws in thyroid cartilage should be smaller than those used for cortical bone. Maximum strength will be achieved using a 1.5 mm screw in a 0.76 mm drill hole.

Globus sensation after laser-assisted uvulopalatoplasty.

PURPOSE: To determine the cause of globus sensation following laser-assisted uvulopalatoplasty (LAUP). MATERIALS AND METHODS: Sixty consecutive LAUP patients were questioned regarding globus sensation. Palate sensation on globus patients was mapped and compared with asymptomatic LAUP control patients. Symptomatic patients were tested again 2 months later. RESULTS: There was a 25% incidence of globus with 8% rated severe and 16% rated mild. The globus sensation corresponds to an insensate area of palate (P < .01). Resolution of the symptoms coincides with reemergence of sensation on the palate. CONCLUSION: Sensory dennervation of the central palate is a likely source of post-LAUP globus sensation. As sensation returns, symptoms abate. Palate surgery should be designed with this in mind. It is possible that undiagnosed globus patients may have areas of anesthetic pharynx.

Optic nerve size in traumatic optic neuropathy.

The assessment of traumatic optic neuropathy in a neurologically impaired patient is difficult, and the size of the optic nerve has been suggested as a potential adjunct in differential diagnosis. This controlled retrospective study was designed to evaluate the size of the optic nerve involved in traumatic optic neuropathy when compared to the optic nerve in the noninjured eye. Maxillofacial computerized tomographs of 22 patients were examined; intraorbital optic nerve diameter was measured on injured and noninjured sides, with the examiner unaware of the side of injury. No statistically significant difference in size was found between the traumatized optic nerves and those that remained intact. The authors have concluded that the size of the optic nerve is not a reliable predicator of the presence or absence of traumatic optic neuropathy when measured with computerized tomograph scans.

Effectiveness of surgical management of epistaxis at a tertiary care center.

A retrospective review is presented of 44 consecutive patients requiring hospitalization for epistaxis at a tertiary care center. The study had the following objectives: 1. to identify predictors of surgical treatment, and 2. to compare the effectiveness of different surgical treatments. Length of stay, complications, and cost analysis are also presented. Eighteen patients were successfully treated nonsurgically, whereas 26 patients received surgical treatment. Posterior epistaxis (P<0.05) and an admission hematocrit less than 38% (P<0.05) were significant predictors of surgical treatment. The rebleed rate after first surgical therapy was 33% for embolization, 33% for endoscopic cautery, and 20% for ligation. Since embolization, ligation, and endoscopic cautery may have nearly equivalent failure rates, other factors, such as cost and institutional expertise, should guide the selection of surgical treatment.

Exostoses of the external auditory canal in Oregon surfers.

PURPOSE: The objectives of this study were to determine the cold water exposure necessary to produce exostoses of the external auditory canal in individuals who predominantly surf along the Oregon and/or the northern California coastline and to ascertain from surfers' otologic histories symptoms attributable to exostoses. MATERIALS AND METHODS: Free ear examinations were provided at two surf shops in northern Oregon. The ear canals were examined with an otoscope, and each surfer was given a summary score indicating the percentage of both canals that was obstructed by exostoses. Surfers were then categorized according to the number of years surfing and the number of sessions surfing per year. RESULTS: Twenty-one surfers met our criteria for analysis. The degree of ear canal obstruction significantly increased with increasing number of years surfing (P < .001) and with increasing number of sessions surfing per year (P < .01). The median summary scores were 7.5, 63.0, and 93.0 for individuals who respectively surfed between 1 and 5 years, between 6 and 15 years, and greater than 15 years. The median summary scores were 10.0 for individuals who surfed 50 sessions or less per year versus 87.5 for individuals who surfed greater than 50 sessions per year. Most surfers with exostoses had minimal complaints. Only one patient had a history of surgical treatment. CONCLUSION: Individuals who surf 5 years or less are unlikely to develop exostoses unless they are surfing greater than 50 sessions per year. Exostoses are typically a benign malady that do not require surgical therapy.

Traumatic optic neuropathy. A meta-analysis.

BACKGROUND: The management of traumatic optic neuropathy remains controversial. Reports of improvement have been published after observation alone, treatment with corticosteroids and surgical decompressions. OBJECTIVE: To systematically review the published literature about traumatic optic neuropathy using a meta-analysis. METHODS: We performed a retrospective literature review of case series and case reports of traumatic optic neuropathy. They include all English language cases and selected non-English language cases for which patient data were available. The cases were organized into four grades based on visual acuity and the locations and type of fracture. Grade 1 included patients with visual acuity greater than 20/200 in the affected eye and without a posterior orbit fracture; grade 2, patients with visual acuity between 20/200 and light perception; grade 3, patients without light perception or with a nondisplaced posterior orbital fracture and remaining vision; and grade 4, patients with no light perception and a displaced posterior orbital fracture. A meta-analysis was performed, analyzing for each case the recovery of visual acuity for treatment, fracture pattern, and grade. RESULTS: The recovery of vision in treated patients was significantly better than the recovery in patients receiving no treatment. No significant difference in improvement was found among patients treated with corticosteroids alone, with surgical decompression alone, or with corticosteroids and surgical decompression. Recovery was related to the severity of initial injury, as reflected in the grading system. A trend was noted for better improvement of visual acuity in patients without orbital fractures than those with orbital fractures, and also in patients with anterior orbital fractures than in patients with posterior fractures. CONCLUSIONS: Treatment with corticosteroids, extracranial decompression, or both, is better than no treatment of traumatic optic neuropathy. Because the data are insufficient to determine whether corticosteroids, surgery, or the use of both treatments is most effective, the findings of the ongoing International Optic Nerve Trauma Study should prove valuable. The standardized grading system we developed is a useful tool for comparing studies and treatment protocols.