Faculty Bibliography

We studied the extrusion rate of Paparella type I tympanostomy tubes in the anterosuperior quadrant compared to those placed in the anteroinferior quadrant in a prospective study. Thirty-five patients were evaluated. The duration (mean +/- SEM) in the anteroinferior quadrant was 211 +/- 18 days, whereas the duration in the anterosuperior quadrant was 211 +/- 11 days. We conclude that placement in the anterosuperior quadrant does not prolong duration of these tympanostomy tubes

Lymphatic malformations of the upper aerodigestive tract can present therapeutic challenges. Symptoms associated with these lesions include bleeding, dysphagia, changes in speech, and dyspnea. Surgical therapy is recommended, which often leads to functional interference and cosmetic deformities. Laser photocoagulation of these malformations can control symptoms and may be repeated as necessary, preserving tissue and function. The results in four patients treated with the carbon dioxide laser and in five patients treated with the neodymium-YAG laser were reviewed. Reduction of bulk and improvement of symptoms were achieved in all patients, most of whom required multiple treatments. The average duration of each procedure was 30 minutes. All patients were discharged from the hospital on the same day or 1 day after laser therapy with minimal morbidity. The indications, evolving technique, and results of laser therapy are discussed

Malformations of the arterial and venous systems often are manifested in the head and neck. Low-flow venous malformations are generally benign lesions; however, complications, such as bleeding, obstruction, pain, or cosmetic deformities, may warrant surgical intervention. Treatment of these lesions can be challenging. Laser photocoagulation, particularly with the neodymium-yttrium aluminum garnet (Nd-YAG) laser, has been successful in the majority of patients, with minimal morbidity and good results. Thirty-two patients with low-flow venous malformations of the head and neck were treated with the Nd-YAG laser using low-power density and intermittent short exposures in a punctate nonoverlapping technique. When possible, two glass slides were used to compress the lesion. There was excellent regression with minimal damage to the surrounding tissue. No major complications or morbidity, postoperative pain, or mortality occurred. Lesions occurring in some areas of the head and neck would not have been amenable to standard surgical excision. Follow-up period has ranged from 1 to 8 years. Nd-YAG laser photocoagulation has proved safe and effective for treatment of low-flow vascular malformations of the head and neck

Subglottic stenosis remains a difficult clinical problem with varied management approaches. An accepted procedure has been anterior and posterior cricoid incisions through an external approach for treatment of severe stenoses without a tracheotomy. The holmium:yttrium-aluminum-garnet laser, 2.1 microns wavelength with a pulsed output, is transmissible through standard fibers and ablates soft tissue and cartilage with minimal surrounding damage. This study in in vitro and in vivo animal models shows that this new laser can be used to incise the anterior and posterior cricoid and tracheal cartilages with precise control and may be suitable for endoscopic laryngotracheoplasty

Teratomas of the head and neck are a particular type of developmental malformation or tumor that are composed of cells with a full range of histogenic potential. They occur almost exclusively in the newborn and infancy periods. Treatment is directed at complete surgical removal with preservation of normal anatomic structures

Kawasaki disease (KD) is an acute illness of unknown cause that affects infants and children. The diagnosis is confirmed in patients with prolonged fever and four of the following clinical features: (1) nonexudative conjunctivitis; (2) oral cavity changes; (3) rash; (4) extremity changes; and (5) cervical adenopathy. Complications of KD include coronary artery aneurysms, which may lead to myocardial infarction, chronic coronary insufficiency, or death. We describe a series of 83 patients with KD in whom 43 (52%) of 83 developed cervical adenopathy during their acute illness. Eighteen (42%) of these 43 patients were initially misdiagnosed as having cervical adenitis and were treated with antibiotics. The otolaryngologist may see these patients in referral and should consider the diagnosis of KD in patients with cervical adenopathy, prolonged fever, signs of mucosal inflammation, or rash. Early diagnosis and intravenous treatment with high-dose gamma-globulin is effective in reducing the prevalence of coronary artery abnormalities