Pediatric Olecranon Osteochondral Flap Fractures With Subtle Radiographic Abnormality.

Pediatric olecranon osteochondral flap fractures are shear injuries of the humeroulnar joint with elevation of an articular cartilaginous flap from the subchondral bone of the olecranon articular surface. All previously reported cases included an osteochondral flap containing the coronoid, with varying imaging and fixation methods used. We treated 2 pediatric patients with this injury. One of our patients had a large, displaced osteochondral fracture of the medial semilunar notch including the coronoid, in addition to avulsions of the medial flexor mass and distal ulnar collateral ligament. The other patient sustained a displaced, rotated osteochondral fracture including the coronoid with subsequent humeroulnar subluxation. Both fractures were anatomically reduced and fixed with absorbable suture, leading to excellent results at 1 year. A high degree of suspicion, thorough work-up, and anatomical reduction of all injured structures are paramount in treatment of this rare, difficult-to-diagnose injury.

Intervention for elevated intracranial pressure improves success rate after repair of spontaneous cerebrospinal fluid leaks.

OBJECTIVES/HYPOTHESIS: Spontaneous cerebrospinal fluid (CSF) leaks are associated with increased intracranial pressure (ICP) and considered a manifestation of idiopathic intracranial hypertension. Although postoperative acetazolamide and placement of CSF shunt systems are considered valuable interventions for elevated ICP, the impact on recurrence rate remains unclear. The objective of this study was to systematically review evidence from reported literature to evaluate whether postoperative ICP management reduces recurrence rates after primary endoscopic repair. STUDY DESIGN: Prospective case series and systematic review. METHODS: Demographics, defect location, success rates, and ICP management in spontaneous CSF leak patients were prospectively collected over 8 years. A search was also conducted in PubMed to identify studies reporting cases of spontaneous CSF rhinorrhea. RESULTS: Fifty-six articles with nonduplicated data were identified and combined with a prospective series of 108 patients for a total of 679 patients treated for spontaneous CSF rhinorrhea. Average age was 50.4 years with 77% female. Average body mass index was 35.8 kg/m2 . Defects were most commonly located in the sphenoid sinus (n = 334) followed by the ethmoid (n = 318) and the frontal sinus (n = 46). Successful primary repair was 92.82% in patient cohorts where ICP evaluation and intervention with acetazolamide or CSF shunt systems was performed, but was significantly decreased to 81.87% in series with no active management of elevated ICP (P < .001). CONCLUSIONS: Evaluation and intervention for elevated ICP in spontaneous CSF leaks is associated with significantly improved success rates following primary endoscopic repair. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2011-2016, 2017.

Tinnitus of myofascial origin.

Tinnitus in some instances is due to a primary muscle disorder: myofascial dysfunction of the muscles of the head and neck. Tinnitus of this origin can be diminished in some cases, and completely abolished in others, by appropriate treatment; this includes trigger point deactivation, specific exercises, and treatment of the underlying causes of the muscle dysfunction.

Otolaryngic myofascial pain syndromes.

It has been long recognized in the otolaryngic community that despite great effort dedicated to the physiology and pathology of the ear, nose, throat/head and neck, there are a number of symptoms, including pain in various locations about the head and neck, which cannot be explained by traditional otolaryngic principles. The tenets of myofascial dysfunction, however, as elucidated by Dr. Janet Travell, explain most of these previously unexplained symptoms; furthermore, treatment based on Dr. Travell's teachings is effective in relieving these symptoms.