Traction suture modification to tongue-in-groove caudal septoplasty.

Caudal septal deviation leads to unfavorable esthetic as well as functional effects on the nasal airway. A modification to the tongue-in-groove (TIG) technique to correct these caudal septal deformities is described. With placement of a temporary suspension suture to the caudal septum, manual traction is applied, assuring that the caudal septum remains in the midline position while it is being secured with multiple through-and-through, trans-columellar and trans-septal sutures. From 2003 to 2016, 148 patients underwent endonasal septoplasty using this modified technique, with excellent functional and cosmetic outcomes and a revision rate of 1.4%. This modified TIG technique replaces the periosteal suture that secures the caudal septum to the midline nasal crest in the original TIG technique. This simplifies the procedure and minimizes the risk of securing the caudal septum off-midline when used in endonasal septoplasty.

Rare Thyroid Malignancies: an Overview for the Oncologist.

Anaplastic thyroid cancer, medullary thyroid cancer, primary thyroid lymphoma and primary thyroid sarcoma are rare thyroid cancers that comprise 5-10% of all thyroid malignancies. Unlike well-differentiated thyroid cancers, these malignancies have few treatment options and carry a worse prognosis. The literature surrounding these pathologies is limited, but remains an area of active research. Despite the rarity of these conditions, they remain an important part of the differential diagnosis for any thyroid nodule. Awareness of their presentation, work-up and management is critical for oncologists and head and neck surgeons. The purpose of this article is to provide a broad overview of these malignancies with an emphasis on emerging clinical research and therapies.

Neck dissection: past and present.

The presence of lymph node metastasis to the neck is accepted as one of the single most important adverse prognostic indicators of survival in squamous cell carcinoma of the head and neck. Neck dissection in its various forms is the standard surgical treatment for clinical and subclinical metastatic cancer to the neck. This paper is a review of the anatomy of the neck, history and specific types of neck dissection, indications, therapeutic options, and current challenges in the treatment of metastatic neck disease.

The use of palatal island flaps as an adjunct to microvascular free tissue transfer for reconstruction of complex oromandibular defects.

OBJECTIVE: To determine the efficacy of using palatal island flaps in combination with free tissue transfer for reconstruction of large, complex oral cavity defects. STUDY DESIGN: Prospective evaluation of patients with large, combined defects of the oral cavity reconstructed with palatal flaps in conjunction with microvascular free tissue transfer. METHODS: Elevation of a palatal flap was performed after completion of tumor resection. The flap was rotated and secured into place. A free flap was then harvested and inset to reconstruct the remaining oromandibular defect. Free flaps included the rectus abdominis (6), fibula (16), and radial forearm (6). RESULTS: Large complex oral cavity defects were repaired with a palatal island flap in conjunction with microvascular free tissue transfer in 28 consecutive patients. There were no complications associated with this flap. CONCLUSION: Maximal functional rehabilitation of large, complex oral defects requires independent reconstruction of the various regions of the oral cavity rather than single flap reconstruction. When used as an adjunct to free tissue transfer, the palatal island flap offers a reliable method for reconstructing large combination defects.

Endoscopically assisted diagnosis and treatment of maxillofacial fractures.

The increased availability of endoscopic instrumentation has enabled a number of surgeons to re-evaluate certain traditional open approaches to the treatment of multiple medical conditions. Our favourable early experience with the use of endoscopes in maxillofacial traumatology will be reviewed.

Nasolabial flap reconstruction of oral cavity defects: a report of 18 cases.

PURPOSE: This article describes the successful use of pedicled nasolabial flaps in the reconstruction of various oral cavity defects with or without adjunctive microvascular free tissue transfer. PATIENTS AND METHODS: Twenty-eight flaps were performed in 18 patients, for a variety of oral cavity defects. RESULTS: All flaps healed without evidence of necrosis, infection, or dehiscence. Patient satisfaction with this procedure was high. The use of the nasolabial flap appears to provide an improvement in overall functional outcome. CONCLUSIONS: The inferiorly based nasolabial flap provides reliable coverage of intermediate-sized oral cavity defects when used alone. It can improve mastication and speech when used in conjunction with microvascular free tissue transfer for the reconstruction of large combined defects of the tongue and floor of mouth.

The use of unilateral deep plane neck lifting to improve the aesthetic appearance of the neck dissection deformity.

The primary concerns of head and neck cancer surgeons are, and should remain, the complete extirpation of tumor and the prevention of tumor recurrence. In recent years, numerous advances have been made in the reconstruction of this patient population, significantly improving their functional and aesthetic outcomes. In this article, with an illustrative case example, we present our technique of unilateral deep plane neck lift that may be considered when one is attempting to achieve better symmetry in patients after radical neck dissection.

A logical approach to the thoracic inlet: the Dartevelle approach revisited.

BACKGROUND: Traditionally, Pancoast tumors have been associated with an extremely poor outlook. Recently, Dartevelle and colleagues have noted a significant survival advantage in patients treated by wide en bloc excision. METHODS: Utilizing an illustrative case example, step by step exposure of the lung apex and first rib is provided with the Dartevelle approach. RESULTS: Safe exposure was provided by this combined transcervical and transthoracic approach. CONCLUSIONS: The Dartevelle approach appears to be the favored approach to anterior lung apex or first rib lesions. The combined efforts of an Otolaryngolist-Head and Neck Surgeon and a Thoracic Surgeon may allow for safe, wide en bloc excision of these otherwise difficult to access lesions.

Use of endoscopically placed expandable nitinol tracheal stents in the treatment of tracheal stenosis.

OBJECTIVE: To evaluate the potential utility of a new endoscopically placed expandable tracheal stent in the treatment of benign symptomatic stenoses of the cervical trachea. STUDY DESIGN: Pilot study utilizing a prospectively followed case series. METHODS: An initial group of six patients undergoing stent placement was examined with rigid and flexible endoscopy under anesthesia immediately following stent placement and at postoperative 6 to 8 weeks. Subsequently each patient was followed clinically for a minimum of 6 months. RESULTS: All stents were well tolerated with no observed complications. Immediate reversal of symptomatic airway obstruction without the need for adjunctive tracheotomy was noted in every patient. At 6 weeks, endoscopic confirmation of complete intraluminal mucosalization without formation of any granulation tissue or scar bands within the stented areas was noted in each case. CONCLUSIONS: This preliminary pilot study supports the use of nitinol expandable tracheal stents as an alternative in the treatment of benign symptomatic tracheal stenoses.