Laryngeal alveolar rhabdomyosarcoma involving the true vocal fold in an adult: Case report.

Rhabdomyosarcoma of the larynx is extremely rare in adults, as only 17 well-documented cases have been previously reported in the English-language literature. Of these, only 2 cases (both male) involved the alveolar subtype of rhabdomyosarcoma, and neither involved the true vocal folds. We report a case of alveolar rhabdomyosarcoma of the true vocal fold in 54-year-old woman. She was successfully treated with conservative surgery, radiation, and chemotherapy. Management of head and neck rhabdomyosarcoma has evolved from radical surgery to less morbid procedures supplemented with radiation and chemotherapy. However, because this tumor is so rare in the adult population, no adult-specific treatment regimen has emerged. Nevertheless, the success of treatment in the pediatric population supports its use in adults.

Hand-washing practices of facial plastic surgeons.

OBJECTIVES: (1) To define and characterize knowledge of effective hand hygiene and its scientific basis among practicing facial plastic surgeons; (2) to review the existing literature of, basis for, and guidelines on hand washing in clinical practice; and (3) to motivate and facilitate optimum hand hygiene among facial plastic surgeons. METHODS: National Web-based physician survey and literature review. RESULTS: We conducted a national Web-based survey of members of the American Academy of Facial Plastic and Reconstructive Surgery regarding general patient safety practices. A subset of the survey assessed physicians' knowledge of hand hygiene, including supporting rationale and actual practices. One hundred and twenty-two facial plastic surgeons of various demographics replied to the online survey. Of these, 65 (53%) correctly knew which hand washing agents are most effective at killing microorganisms, 88 (74%) knew the preferred hand-washing method for visibly soiled hands, and 51 (42%) correctly identified the indications for hand washing. CONCLUSIONS: Adherence to hand hygiene practices is suboptimal among facial plastic surgeons. There seems to be a lack of knowledge regarding indications, methods, and appropriate agents for hand hygiene. Promotion of Centers for Disease Control and Prevention guidelines is an important step in increasing hand hygiene compliance among facial plastic surgeons.

Flexible laser bronchoscopy for subglottic stenosis in the awake patient.

OBJECTIVE: To describe our technique and experience of treating adult subglottic stenosis using the Nd:YAG laser through a flexible bronchoscope via a fiberoptic delivery system. DESIGN: Retrospective chart review. PATIENTS: This study included 16 patients with subglottic stenosis who presented to the senior surgeon (M.R.R.) for laser bronchoscopy from January 2000 to December 2006. MAIN OUTCOME MEASURES: Progression toward decannulation and preoperative and postoperative symptoms were assessed. RESULTS: Four of 7 patients who required tracheostomy tubes at the start of laser bronchoscopy underwent decannulation. None of the remaining 9 patients required tracheostomy tubes during treatment. All patients had improvement in their symptoms. Complications of the procedure were minimal. CONCLUSIONS: Bronchoscopy with the Nd:YAG laser is a well-tolerated and effective treatment for subglottic stenosis. Laryngotracheal trauma caused by an endotracheal tube and/or rigid bronchoscope is avoided. This procedure may be useful to achieve and maintain a patent airway.

Orbital floor reconstruction using porcine small intestinal submucosa.

BACKGROUND: We conducted a prospective, controlled, blinded pilot study to demonstrate that repair of induced rabbit orbital floor fractures with Surgisis ES (Cook Biotech Inc, West Lafayette, Ind) provides adequate orbital content support while promoting mucosal and bone regeneration of the fracture site. MATERIAL/METHODS: Ten New Zealand white rabbits underwent induced bilateral controlled (5mm) orbital floor fractures under anesthesia. In each rabbit, Surgisis ES, an acellular, freeze-dried soft tissue matrix derived from porcine small intestinal submucosa, was implanted subperiosteally to repair one orbital floor fracture through a transconjuntival approach. The contralateral orbital floor fracture served as a control. Histological assessment was performed at 1, 3, and 12 months post-operatively. RESULTS: All ten rabbits survived the surgery without infection, globe entrapment or implant rejection. Grossly, the orbits appeared similar in the ten rabbits. Subtle histological differences were noted between the fractures repaired with Surgisis ES and those left to heal without treatment. Eosinophilic infiltrates and connective tissue fibrosis found to varying degrees in the Surgisis ES sites were not found in the control sites. Previous Surgisis studies found a foreign body giant cell reaction that was absent in this study. Both sites were healed at all intervals. CONCLUSIONS: Surgisis ES can successfully serve as a graft in the repair of orbital floor fractures in rabbits. However, its ability to promote central bone regeneration has not been clearly established. Additional studies investigating its application in human orbital trauma are needed.

Static facial suspension with Surgisis ES (Enhanced Strength) sling.

BACKGROUND: Static suspension procedures stabilize and support paralyzed facial muscles and enhance facial symmetry, appearance, mastication, and speech production in patients with facial palsy. A variety of autografts and allografts have been used for static facial suspension, but each has its limitations, and few studies document the efficacy or benefit of one substance over another. Xenograft tissue scaffoldings potentially offer both the compatibility of autografts and the convenience of allografts. OBJECTIVE: Pilot study to evaluate efficacy of Surgisis ES (Enhanced Strength) static facial suspension in a series of six patients with facial paralysis. METHODS: Retrospective chart review, illustrative case series, and review of the literature. RESULTS: Six patients with facial paralysis were treated with the Surgisis ES facial sling procedure. Four patients achieved satisfactory results after the initial procedure. One patient was displeased with the esthetic outcome and required a revision procedure to increase the tautness of the implant. In the initial four cases, the sling was tunneled subcutaneously and sutured to the muscle. In two cases, the sling was tunneled subcutaneously and subperiosteally, thereby suspending all the soft tissue in the midface. CONCLUSION: Static facial suspension with Surgisis ES improved cosmesis and function in this limited pilot study. In particular, a two-plane dissection technique provided excellent results. Further studies need to be conducted to evaluate the ongoing benefit over time.

Lip augmentation with porcine small intestinal submucosa.

OBJECTIVE: To relate our initial experience using an acellular, soft tissue matrix derived from porcine small intestinal submucosa (Surgisis; Cook Biotech Inc, West Lafayette, Indiana) for lip augmentation. DESIGN: A prospective, uncontrolled case series examining the results of lip augmentation using Surgisis in patients presenting to an academic otolaryngology/facial plastic surgery office. RESULTS: Nineteen Surgisis implants were placed in 8 patients. All patients tolerated the procedure and denied unnatural sensations or complications at any interval. Adverse events included transient erythema and 1 case of local cellulitis treated effectively with oral antibiotics. Four patients were satisfied with the procedure and 4 patients requested greater augmentation. Six-month follow-up was reported, and preoperative and postoperative photography was used in all cases. CONCLUSIONS: Short-term lip augmentation was achieved in all 8 patients (4 patients had multiple strands placed). This study demonstrates technical ease and early safety. Surgisis should serve as scaffolding for ingrowth of striated muscle of the lip, potentially providing long-term augmentation. This study introduces Surgisis as a novel implant for lip augmentation.