Faculty Bibliography

CONCLUSIONS: The historical study of serous otitis media (SOM) demonstrates steps in recognition of the disease, shifts in prevalence, and relationships between the disease's affect and evolving economic bases of society. OBJECTIVE: SOM, although noted in early Roman and Arabic medicine, was only identified as a distinct and significant pathology in the last half of the 20th century. This paper examines the development of understanding of SOM, and ways in which it has been cared for during the 20th and 21st centuries. MATERIALS AND METHODS: The medical literature from antiquity to the present was reviewed for mention of otological conditions that related to SOM. For this report, the primary source of each notation was examined. RESULTS: The first part of the 20th century saw little change from earlier times in the recognition or treatment of SOM. Our current 21st century conceptualization and concern for SOM has come about from five advances: antibiotics, the rediscovery of the tympanostomy tube, the clinical use of middle ear impedance, the association of a history of otitis with linguistic deficiency, and recognition of the significance of transformation to a communication-based economy.

OBJECTIVES/HYPOTHESIS: The successful harvest and transplant of a fibular flap depends on many factors, including healthy inflow and outflow systems. A contraindication to harvesting a fibular flap is disease of the lower extremity arterial system; therefore, preoperative evaluation of the arterial system is routine. Preoperative evaluation of the venous system is not routine, unless there is clinical suspicion of venous disease. METHODS: Retrospective chart review. RESULTS: Two cases of occult deep venous thrombosis (DVT) were encountered intraoperatively resulting in nontransplantable flaps. CONCLUSIONS: This finding represents a serious concern, and we believe that venous imaging should be considered in patients with significant risk factors for harboring an occult DVT. Laryngoscope, 2009.

BACKGROUND: In the past, surgeons believed that in order to eradicate regional disease, a radical or modified radical neck dissection was necessary. An evolution in surgical principles and the popularization of primary chemoradiation has raised the questions regarding the role of neck dissection and the extent of neck dissection following therapy. The aim of this study was to determine the efficacy of selective neck dissection (SND) for patients with N2 or N3 disease following treatment with primary radiation therapy or chemoradiation. METHODS: A retrospective review of 58 patients with stage III or IV head and neck squamous cell carcinoma was conducted. The primary sites included base of tongue (n = 15), hypopharynx (n = 12), tonsil (n = 16), larynx (n = 11), and unknown primary (n = 4). Definitive treatment consisted of either concomitant chemoradiation (67.2%) or external beam radiation therapy (32.8%). In the monotherapy group, all patients received a total curative dose of 66 to 72 Gy in once-daily fractions of 180 to 200 cGy. The combined chemoradiation group received a similar radiation schedule and a 4-day continuous infusion of cisplatin (20 mg/m(2)/day) and 5-fluorouracil (1000 mg/m(2)/day). A planned SND of levels II to IV was performed on all the patients 3 to 6 weeks after completion of definitive medical therapy. RESULTS: Seventy neck dissections were performed on 58 patients with advanced neck disease following radiation or chemoradiation. The median time of follow-up was 34 months (range, 9-71 months) following the neck dissection. Pathologically, 22.4% (13/58) of the patients had viable tumor cells identified in the neck dissection specimen. Seventy-two percent of the patients are currently alive, and 28% died as a result of distant disease, local or regional recurrence, or other causes. Of patients who died from distant disease, 11% had pathological evidence of residual tumor cells identified in the neck dissection specimen. Of patients who died from local or regional disease, 50% had pathological evidence of residual tumor cells identified in the neck dissection specimen. CONCLUSION: The rate of regional recurrence following SND is similar to reported rates following modified/radical neck dissection. This suggests that SND provides an appropriate surgical option for advanced neck disease in select patients following adjuvant therapy.

BACKGROUND: A devastating sequela of facial paralysis is the inability to close the eye. The resulting loss of corneal protection can lead to exposure keratitis, corneal ulceration, and potentially permanent vision loss. Methods to address lagophthalmos historically have included tarsorrhaphy, lid weighting, levator palpebrae superioris lengthening, chemodenervation to yield protective ptosis, and the placement of magnetic eyelid springs. The gold eyelid weight, introduced nearly 50 years ago, continues to enjoy immense popularity, despite high complication rates and nearly uniform visibility under the skin. The authors hypothesized that a commercially available, thin platinum weight would combat the visibility of the thicker gold weights and herein compare complication rates and visibility rates with literature-reported data for gold weights. METHODS: Beginning in 2004, 100 consecutive patients presenting to the authors' Facial Nerve Center with paralytic lagophthalmos requiring intervention were treated with thin-profile platinum eyelid weights. Ninety-six percent of cases were performed under local anesthesia in the office setting. RESULTS: Median follow-up was 22 months. In 102 weights placed, there have been six complications (5.9 percent): three extrusions, two capsule formations, and one case of astigmatism. All of the extrusions involved irradiated patients with parotid malignancies. CONCLUSIONS: The authors report the first large series of thin-profile platinum eyelid weight implantations for the treatment of lagophthalmos. This implant significantly reduces both capsule formation phenomena and extrusion compared with gold weights and should be considered as alternative to the more conventional gold implants.

A 48-year-old woman with a history of chronic intranasal cocaine abuse presented with unilateral proptosis associated with severe visual loss from optic neuropathy in the right eye. Imaging showed extensive bone and soft tissue destruction in the paranasal region and an orbital mass. Initial biopsies suggested a low-grade neoplasm. The correct diagnosis was established only on repeat biopsy, which revealed marked pleomorphism and nonspecific chronic inflammation with irregular collagen bundles containing thick-walled blood vessels. This case emphasizes that intranasal cocaine abuse may clinically, radiographically, and histopathologically mimic a neoplasm or a necrotizing vasculitis.

BACKGROUND: The search continues for the "ideal" repair of the midline ventral hernia, and the components separation technique has a low, but still concerning, hernia recurrence rate. The authors hypothesize that adding prosthetic or bioprosthetic meshes to the midline closure during components separation would reduce recurrence rates with minimal added morbidity. METHODS: Over a 3-year period, patients had a components separation procedure where either acellular cadaveric dermis (n = 26) or soft polypropylene mesh (n = 28) was used as an intraperitoneal underlay for reinforcement of the midline repair, but not as a "bridging material." In 36 operations, the mesh or cadaveric dermis was placed at the time of the components separation, and in the remaining cases (n = 18), the underlay was used to treat a recurrence after components separation. RESULTS: Cadaveric dermis was associated with a 46 percent "true" recurrence rate that required reoperation (mean follow-up, 17.3 months), whereas soft polypropylene mesh had a significantly lower recurrence rate of 11 percent (p = 0.0057) during a follow-up period of 16 months. Because of a higher incidence of concomitant bowel surgery and contamination in the cadaveric dermis group, additional subset analysis of uncontaminated cases was performed, demonstrating a 61 percent recurrence rate for cadaveric dermis compared with 12 percent for soft polypropylene (p = 0.0017). No significant differences in major and minor complications were seen between groups. CONCLUSION: Soft polypropylene mesh, but not acellular dermis, demonstrates acceptably low complication and hernia recurrence rates when used as a reinforcement of the midline ventral hernia closure in conjunction with components separation.

OBJECTIVES: To determine the efficacy and describe the evolution of the "components separation" technique for abdominal wall repair in 200 consecutive patients. DESIGN: Retrospective medical record review. SETTING: Northwestern Memorial Hospital, Chicago, Illinois. PATIENTS: Two hundred consecutive patients who underwent ventral hernia repair using the components separation technique. INTERVENTIONS: Biological and permanent meshes were used in select patients to augment the repair of the midline fascial closure but were not used as "bridging" materials. MAIN OUTCOME MEASURES: Hernia recurrence rates and major and minor complication rates for the overall series and for the different techniques. RESULTS: Primary components separation (n = 158) yielded a 22.8% recurrence rate. Closure of the midline tissues with augmentation of the repair using an acellular cadaveric dermis underlay (n = 18) had a 33.3% recurrence rate requiring a second operation, whereas intra-abdominal soft polypropylene mesh (n = 18) had 0% recurrence (P = .04). Elevated body mass index was a significant risk factor predicting hernia recurrence (P = .003). Contamination (P = .04) and enterocutaneous fistula (P = .02) at the time of surgery were associated with increased major complications, whereas body mass index (P = .01) and diabetes mellitus (P = .04) were associated with increased minor complications. CONCLUSIONS: Large complex hernias can be reliably repaired using the components separation technique despite the presence of open wounds, the need for bowel surgery, and numerous comorbidities. The long-term strength of the hernia repair is not augmented by acellular cadaveric dermis but seems to be improved with soft polypropylene mesh.

This article reviews major salivary gland anatomy and the differential diagnosis of salivary gland disease. The surgical technique for parotid and submandibular gland excision is described in detail. Possible complications and their management are also discussed, followed by a brief literature review of new surgical techniques.

To date, major works on tracheomalacia have assumed a structural etiology and have proposed therapies as such. We describe a possible neurologic etiology for tracheomalacia in a child with clinically significant tracheomalacia that resolved in synchrony with each treatment of his recurring hydrocephalus. Endoscopy confirms remarkable expansion of tracheal diameter 7 days after decreasing intracranial pressure. The possibility of a neurologic etiology for tracheomalacia casts this condition in a new light with potential therapeutic implications.