Comparing autologous versus allogenic rib grafting in pediatric cleft rhinoplasty.

BACKGROUND: Patients with cleft lip with or without cleft palate suffer from varying degrees of nasal deformity, often requiring nasal reconstruction to provide improved form and function. Rib cartilage is an excellent source of grafting material for nasal reconstruction and is available either as an autologous or allogenic graft. There is a paucity of literature comparing outcomes of autologous and allogenic rib grafts in pediatric cleft rhinoplasty. METHODS: A retrospective chart review was performed on patients who underwent cleft rhinoplasty with autologous or allogenic rib grafting at a tertiary pediatric hospital between January 1, 2003 and December 31, 2017. Outcome data were gathered over a 6-month postoperative period. RESULTS: There were 23 cleft rhinoplasties performed with rib graft, 12 with autologous rib and 11 with allogenic rib. Those in the autologous group tended to be older than those in the allogeneic group (15.6 ± 4.4 v 12.4 ± 5.2 years, p = 0.13). The most common types of grafts used were columellar strut (20/23), shield graft (9/23), and unilateral or bilateral batten grafts (7/23). Length of stay was significantly longer for patients who underwent autologous rib grafting compared with those with allogenic rib grafting (25.8 ± 4.7 v 11.9 ± 7.2 h, p < 0.05). Each group reported one complication. CONCLUSION: Autologous and allogenic rib grafts are safe and effective in pediatric rhinoplasty. The most common grafts used in this sample were columellar strut, batten, and shield grafts. Autologous rib grafts were more likely to be used in older patients and require longer hospital stay compared to allogenic grafts.

Fourth branchial cleft sinus with foreign material within thyroid gland.

Fourth branchial cleft anomalies are rare lesions that present diagnostic dilemmas to otolaryngologists. The report presented is a case of a 17-year-old female with food matter and abscess within the thyroid gland that were associated with a 4th branchial cleft sinus. A thyroid ultrasound revealed a 3.0 x 1.5 x 2.5-cm lesion with abnormal echogenicity that was concerning for early abscess. The patient subsequently underwent direct laryngoscopy and right thyroid lobectomy. Her symptoms resolved after surgery. This case demonstrates an unusual presentation in which food passed through the tract to the thyroid gland itself.

Patient Satisfaction after Aesthetic Chondrolaryngoplasty.

BACKGROUND: Patient's pursuing aesthetic surgery often inquire about the success of the procedure. Having objective data for these patients improves preoperative counseling. To assess patient satisfaction after aesthetic chondrolaryngoplasty using specifically developed outcomes assessment instrument and to evaluate the anatomy of the vocalis insertion on the thyroid cartilage and its effect on the extent of surgical resection. METHODS: Retrospective survey of patients who underwent chondrolaryngoplasty from 2006 to 2012. Patients answered 6 questions on a 5-point Likert scale assessing satisfaction from a physical, emotional, and social quality of life perspective. We separately undertook cadaveric dissection to examine the ligamentous attachment of the vocal fold to the thyroid cartilage.All patient were seen in a private practice affiliated with a university medical center.One hundred ninety-eight patients underwent chondrolaryngoplasty during the study period; we were able to contact 112.The main outcome measure is patient satisfaction using a 5-point Likert Scale. RESULTS: Sixty percentage of patients were either "very" or "completely" satisfied with the appearance of their neck and Adam's apple. Only 13% still reported that their neck/Adam's apple still appeared unsatisfactorily prominent or masculine. No patients had permanent voice change, and greater than 90% of patients had no significant voice change of any duration; any voice change was temporary. The most frequent comments from less satisfied patients were the amount of remaining prominence and the size or location of the scar. CONCLUSIONS: Aesthetic chondrolaryngoplasty is a safe and effective surgery to reduce the prominence of the thyroid cartilage. Patients should be aware that because of the need to preserve voice it may not be 100% effective from an aesthetic perspective.

Peripartum Management of Neonatal Pierre Robin Sequence.

Pierre Robin sequence (PRS) is a congenital condition characterized by the presence of micrognathia, glossoptosis, and cleft palate. PRS has varying effects on airway patency and feeding ability and thus has a broad range of management options. The purpose of this article is to describe the nature of the background of the condition and address the previous and current trends in diagnosis and management of PRS.