Sternoclavicular joint swelling after surgery of the head and neck region: a case report and differential diagnostic review.

BACKGROUND: Very few published reports in the otolaryngologic literature discuss sternoclavicular joint swelling encountered in the postoperative setting. METHODS: The authors document a case of sternoclavicular joint swelling after medialization laryngoplasty. This report is supplemented with a review of the medical literature related to pertinent conditions affecting the sternoclavicular joint. CONCLUSIONS: In our patient, swelling was thought to be related to joint trauma experienced during surgery secondary to standard shoulder roll extension in a patient with preexisting postmenopausal arthritis. This case stands in contrast to the body of documented cases of postoperative sternoclavicular swelling in which the surgical procedure itself was responsible for such findings.

Comparison of microflap healing outcomes with traditional and microsuturing techniques: initial results in a canine model.

A prospective, blinded study was designed to determine whether placement of a microsuture in epithelial defects created on canine vocal folds results in histologically demonstrable improved heating. Epithetial defects similar to those created during microflap removal were made by means of traditional microsurgical techniques on both vocal folds of 4 adult dogs. One vocal fold defect on each dog was then closed with a single microsuture placed through the laryngoscope. The larynges were harvested approximately 6 weeks later, and blinded histologic quantification of scar formation was performed. Microsutures resulted in less scarring in all but 1 of the larynges studied. Unsutured vocal folds exhibited a 75% larger average scar cross-sectional area. Although the sample size was insufficient to establish statistical significance, the observed difference in scar formation between microsutured and unsutured vocal folds suggests that primary closure with a microsuture in the canine model results in less scarring than when healing occurs by secondary intention.

Laryngeal pseudosulcus as a predictor of laryngopharyngeal reflux.

OBJECTIVES/HYPOTHESIS: Laryngeal pseudosulcus is an accurate prognostic indicator of laryngopharyngeal reflux (LPR) disease. STUDY DESIGN: Prospective study of 20 consecutive patients with laryngeal pseudosulcus. Pseudosulcus is infraglottic laryngeal edema that is thought to be secondary to LPR. All patients were evaluated with dual-channel pH probe 24-hour monitoring to evaluate for the presence of laryngopharyngeal reflux. METHODS: Twenty patients identified with laryngeal pseudosulcus on routine physical examination were included in the study. Each patient underwent a 24-hour dual-channel pH probe. The data were analyzed and compared with previously published normative data. The data included the total number of reflux episodes and the percentage of time the pH dropped below 4 at the proximal probe. RESULTS: Eighteen of the 20 patients with laryngeal pseudosulcus were found to have LPR. The mean number of reflux episodes at the proximal probe was 29.4 (range, 3-82). The mean percentage of time the pH dropped below 4 was 1.15%. In the upright position the mean value was 1.59% and in the supine position it was 0.19%. This gives pseudosulcus a positive predictive value for LPR of 90%. CONCLUSION: This study shows laryngeal pseudosulcus to be an accurate predictor of laryngopharyngeal reflux disease.

Medical and vocal history in the evaluation of dysphonia.

Dysphonia is one of the more common complaints resulting in referral to the otolaryngologist-head and neck surgeon. The accurate diagnosis and management of dysphonia is based on a complete medical and vocal history. This article presents an approach to elicit pertinent information from the patient presenting with dysphonia. The evaluation is divided into the history of present illness, past medical history, past surgical history, review of systems, medications, and a social history.

Histologic findings of silastic medialization in the canine model.

OBJECTIVES: Examine the long-term histological effects of Silastic medialization using a canine model. STUDY DESIGN: Prospective study evaluating the effects of Silastic medialization in six canine larynges. METHODS: Two subject groups were evaluated. The first group of four dogs underwent recurrent laryngeal section followed by Silastic medialization on the paralyzed side and placement of a smaller implant on the mobile side. Two of the dogs were sacrificed at 9 months and two at 2 years. The second subject group consisted of two additional dogs who underwent Silastic medialization followed by removal of the implants at 7 months and were sacrificed 18 months later. The larynges were then processed, sectioned in the axial plane, and examined microscopically. RESULTS: Histological findings of both the mobile and paralyzed sides showed a thin (< 0.5 mm) fibrous capsule surrounding the implant and minimal inflammatory response. Vocal fold mobility was maintained in all cases in which the recurrent laryngeal nerve was left intact. Capsule formation and inflammatory response were similar in all cases. CONCLUSIONS: Minimal tissue reactivity over a prolonged period of time suggests that long-term results of Silastic medialization remain stable in paralyzed and mobile vocal folds for up to 2 years. Similar tissue response in the subjects in which the Silastic block was removed also suggests that Silastic medialization is a reversible procedure.

Speech outcomes after laryngeal cancer management.

As our ability to treat laryngeal cancer and prolong the lives of our patients improves, we must place increasing importance on maintaining the best voice possible in every case. Treatment options for laryngeal cancer continue to expand, and it is important that otolaryngologists stay well informed; not only concerning the local control and disease-free survival associated with each new treatment, but also the expected voice result. This article describes the voice and speech outcomes that are associated with various treatments for laryngeal cancer. In addition, comparisons of the expected voice results for different therapeutic modalities are examined.

CT evaluation of the paranasal sinuses in symptomatic and asymptomatic populations.

The frequency of concha bullosa, paradoxical middle turbinate, and septal deviation on coronal computed tomographic scans evaluating sinus disease is known, but the incidence in normal subjects is unknown. We compared 100 consecutive scans performed for evaluation of sinus disease with 82 consecutive scans performed for evaluation of orbital pathology. Patients with sinus disease had significantly more frequent findings of disease in the osteomeatal complex and all sinuses. Concha bullosa was more common in patients with sinus disease (p less than 0.05), as was septal deviation (p less than 0.01). Paradoxical turbinate was equally common. Concha bullosa was associated with anterior ethmoid disease (p less than 0.04). Septal deviation was associated with osteomeatal complex disease (p less than 0.01) and with anterior (p less than 0.04) and posterior (p less than 0.04) ethmoid disease. Paradoxical turbinate was not associated with sinus abnormalities. These data imply a possible causal relationship between concha bullosa or septal deviation and sinus disease.