Sinusitis. How to recognize and treat it.

Sinusitis is a widespread but often misunderstood disorder. The precipitating factor in acute sinusitis appears to be blockage of the sinus ostium. The patient's history usually leads to the diagnosis. Antibiotics and decongestants are the mainstays of treatment. In some cases, surgical treatment may be necessary. Chronic sinusitis is more difficult to diagnose because symptoms are nonspecific. Antibiotics, decongestants, and, in some cases, nasal steroids should be given. If these agents are ineffective, surgical drainage may be considered.

Congenital subglottic stenosis: the elliptical cricoid cartilage.

Various malformations of the cricoid cartilage produce congenital subglottic stenosis. The elliptical cricoid cartilage first was demonstrated histopathologically in horizontal sections of six postmortem specimens and now has been identified clinically in ten patients. The clinical diagnosis of the elliptical cricoid cartilage, suggested by anteroposterior soft tissue neck films, is confirmed at direct laryngoscopy. Delineation of the precise location, extent, and histopathology of subglottic stenosis provides the basis for rational management.

Management of laryngeal radionecrosis: animal and clinical experience.

Radiation necrosis of the laryngeal cartilages is an uncommon complication of radiotherapy for laryngeal carcinoma. It is a devastating process for which there is no one acceptable treatment. Medical management offers only temporary, symptomatic relief, which further necessitates surgical treatment. Surgical management may start with a tracheotomy; however, it often ends with a total laryngectomy. Physiologically, the necrotic cartilages are the source of the problem. It is a general surgical principle that nonviable tissue must be excised to promote healing. Therefore, if the affected laryngeal cartilages were removed, the larynx should heal. Total or near total removal of the thyroid and cricoid cartilages with preservation of the endolaryngeal soft tissues has not been reported in the literature. Theoretically, if the entire cartilaginous framework is removed, there would be no structural support for the airway. We have found using animal models, that submucosal resection of the laryngeal cartilages, leaving the perichondrium and endolaryngeal soft tissues intact can result in a competent airway. Animal and clinical experience will be presented.

Surgical management of aspiration.

Chronic recurrent aspiration can occur in patients suffering from a diverse group of pathologic processes. Many innovative surgical procedures are available to compensate for severe functional deficits. Some of these procedures can be reversed if the patient recovers from his or her underlying disability. An open-minded, eclectic approach is the best way of preventing the disastrous sequelae of chronic aspiration.

The rhombotrapezius myocutaneous and osteomyocutaneous flaps.

As more radical surgery is being performed for head and neck cancer, an increasing variety of flaps for reconstruction have been developed. The more common myocutaneous flaps for large defects are the pectoralis major, trapezius, and latissimus dorsi flaps. The lower trapezius flap, which is used for reconstruction of large lateral facial defects, is a relatively thin flap. The rhombotrapezius flap described in this article provides bulk for augmentation of facial defects. The flap, which includes the trapezius and rhomboid muscles, also offers a longer pedicle with a greater arc of rotation. This flap may include the medial border of the scapula when bone is necessary. The addition of the rhomboid muscles incorporates the dorsal scapular artery, which gives an additional blood supply to the flap. We believe that the rhombotrapezius, myocutaneous, and osteomyocutaneous flaps have a significant advantage over previously described flaps in the treatment of defects that need greater bulk and length for adequate reconstruction.