Amyloidosis: Uncommon cause of dysphonia

Otolaryngology– Head and Neck Surgery Volume 131 Number 2

P107 Radial Artery Graft for Bypass of the Maxillary to Proximal Posterior Cerebral Artery Cagatay Han Ulku, MD (presenter); Erkan Ustun, MD; Mustafa Buyukmumcu, PhD; Aynur E Cicekcibasy, MD; Taner Ziylan, PhD Konya Turkey; Konya Turkey; Konya Turkey; Konya Turkey; Konya Turkey

Objectives: Patients complaining with vertigo or dizziness, the pathology may be originated from central or peripheric compartment. These cases frequently apply to the Neurology, Neurosurgery, or ENT Clinics. The vertebro-basilar insufficiency is one of the most common pathologic causes of central vertigo or dizziness. This study aims to examine the use of a radial artery graft for bypass of the maxillary artery (MA) to proximal posterior cerebral artery (PCA) as an alternative to external carotid artery (ECA) to PCA anastomosis used for posterior circulation bypass surgery. Methods: This method was applied to 5 adult cadaver sides bilaterally. The MA was easily found 1–2 cm beneath to infratemporal crest, after a frontotemporal craniotomy and a zygomatic arch osteotomy. Extradurally 2–3 cm posterolateral to the foramen rotundum, a hole was drilled in the sphenoid bone with a 4-mm tipped drill. After sylvian fissure, interpedincular and ambient cisterns were opened, the P2 segment of the PCA appeared. The graft was passed through the hole and the dura to reach the P2 segment. Before giving the infraorbital artery (IOA) branch, the MA was freed from the surrounding tissue and transsected. The proximal side of the radial artery graft was anastomosed end-to-end with MA and distal side end-to-side with P2 segment of PCA.

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Results: The average diameter of the MA before giving the IOA branch was 2.6 ⫾ 0.3 mm.The average diameter of the P2 was 2.2 ⫾ 0.2 mm.The average length of the graft was 47 ⫾ 5.2 mm. Conclusion: Since MA to proximal PCA bypass uses a short radial graft and may provide a sufficient blood flow, it can pose a reasonable alternative to ECA to PCA bypass. P108 Evaluation of Postoperative Morbidity in Pediatric Tonsillectomy with Sucralfate Andre Luiz Lopes Sampaio, Oliveira, MD PhD Minneapolis MN; Brasilia Brazil

MD PhD

(presenter); Carlos A

Objectives: To evaluate the efficacy of sucralfate in alleviating posttonsillectomy morbidity in a pediatric group of patients Methods: A prospective double-blind, randomized, and controlled study comparing the irrigation of a solution containing either 1 g of sucralfate or 1 g of lactose was conducted on 58 children undergoing tonsillectomy, after the purpose and method of study were described to the parents, at Brasilia University Hospital. The anesthetic was standardized and no premedication was used; no analgesic drugs were used during the procedure. Tonsillectomy was performed using cold dissection by the same attending surgeon. Each patient used the same solution to swish and swallow 4 times daily during 7 days. Pain using Mcgraft analogue scale, vomiting and bleeding, time to return to normal diet, analgesic drugs intake, changes in the weight and temperature and interincisor teeth distance were assessed by the same author 6, 12 hours, and 7 days after the surgery. Results were compared between groups using t test and P value was considered statistic significant when it was less than 0.05. Results: We evaluated 29 children in each group with ages ranging from 3 to 12 years (mean, 6,2). We found no demographic difference between the groups. No patient was excluded from the study. No statistic difference between the groups was found comparing the parameters above, as well as, no difference was found in the evolutive assessment of the face scale for pain between the groups. Conclusion: Sucralfate showed no benefice in alleviating posttonsillectomy morbidity in this group of patients. P109 Amyloidosis: Uncommon Cause of Dysphonia Vicente Villagomez, MD (presenter); Felicitos Santos, MD; Ramiro Santos, MD; Jose L. Trevino, MD (presenter); Eduardo Cantu, MD Monterrey Mexico; Monterrey Mexico; Monterrey Mexico; Monterrey Mexico; Monterrey Mexico

Objectives: Case report of 3 cases of laryngeal amyloidosis

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formed a bilaterally epithelisized forearm flap under application of vacuum-assisted prelamination technique. Stabilization of the flap was achieved by insertion of rib cartilage during the preconditioning period. In a second surgical session, the flap was transferred to the throat and vascularized by microvascular anastomosis to cervical vessels. Results: In both patients, surgery was successful and resulted in closure of the tracheostoma, and in speech and swallowing rehabilitation. The neolarynx remained stable during the follow-up period of 12 months. Conclusion: Subtotal laryngectomy requiring a permanent laryngostoma or tracheostoma is associated with severe impairment of the patient and lifelong reduction of his quality of life. Reconstructive methods after subtotal anterior laryngotracheal resection published so far have not really been convincing. We present a successful method, combining the modern surgical and biomedical techniques of prelamination and preconditioning for extended laryngotracheal reconstruction, resulting in the restoration of a stable neolarynx and upper trachea. Our report indicates that previous or subsequent irradiation is no contraindication to this reconstruction procedure.

Scientific Posters

Scientific Posters

Methods: Three cases of localized amyloidosis without systemic disease were identified at Centro Univerisitario de Otorrinolaringologia y Cirugia de Cabeza y Cuello at the Univerisity Hospital in Monterrey Mexico. In each patient the major site of involvement was glottic with small focus in the false vocal folds. Medical workup including full blood count, CSR, urea, electrolytes, ureanalysis, liver function test, chest x-ray, were performed. Physical examination ruled out systemic disease. Congo red staining confirmed the diagnosis in all surgical specimens. Results: Localized laryngeal amyloidosis was identified in 3 patients (2 males and 1 female) with ages ranging from 33 to 67 years. The presenting symptoms including hoarsness, throat soreness, voice breaks, and vocal fatigue. The duration of the symptoms before diagnosis varied from 3 to 12 years. Assesstment of the extent of laryngeal spread of disease included CT scan, complete voice analysis, and videolaryngostroboscopy in all patients. Material for biopsy was obtained by direct laryngoscopy, apple-green birefringence was seen with congo red stain establishing the histological diagnosis. The 3 patients underwent phonomicrosurgery for removal of the amyloid implantation using cold knife excision. Conclusion: Laryngeal amyloidosis is a rare disease with an 8 in 1,000,000 presentation rate. It is more common in males with 3:1 prevalence in the fifth decade. Once the diagnosis is confirmed by congo red staining, it is important to rule out systemic amyloid involvement. It is not necessary to do invasive approach on localized disease. Cold knife excision is still a good method to remove the deposition. P110 Impact of Rehabilitation Facility on Outcomes in Head and Neck Surgical Patients Nitin Bhatia (presenter); Rahul K Shah, MD; Marlon Villacorta, RN; Racheal McQuillan, NP; Donald J Annino, Jr, MD DMD; Elie E Rebeiz, MD FACS Boston MA; Brookline MA; Boston MA; Boston MA; Boston MA; Boston MA

Objectives: To determine the significance of in-hospital rehabilitation facility versus distant rehabilitation facilities in the outcomes and complications of postoperative head and neck surgical patients. Methods: Retrospective review of head and neck surgical patients over a 5-year period at a tertiary care medical center. Results: Fifty patients met criteria for this study (35 males, 15 females). Forty-two patients had a primary squamous cell carcinoma, and 8 patients had other primary malignancy of the head and neck. Thirty-two patients were placed in an in-hospital rehabilitation facility, and 18 patients were placed in distant rehabilitation facilities (average distance 40.9 miles; range 2–250 miles). Seventeen patients (34%) had complications including infection/drainage (7 patients), fistula (6 patients), pneumonia (2 patients), wound dehiscence (2 pa-

tients), bleeding from carotid stump, fluctuance, exudate, ulcer, eschar, delay in Blom-Singer valve teaching and displacement. The difference between the rate of complications among the 2 groups was not statistically significant (37.5% in-hospital rehabilitation, 27.8% distant rehabilitation; P ⫽ 0.496). The difference between the rate of hospital readmission was not statistically significant either (25% for in-hospital rehabilitation patients and 16.7% for distant rehabilitation patients; P ⫽ 0.505). The average length of stay of patients without complications was 18.5 days (SD ⫽ 17) for in-hospital rehabilitation and 12.9 days (SD ⫽ 5.8) for distant rehabilitation. This difference was not statistically significant (P ⫽ 0.346). Conclusion: One third of postoperative head and neck surgical patients developed complications while in a rehabilitation facility. The length of stay, hospital re-admission rate, and frequency of complications does not correlate with the distance of the rehabilitation facility from the treating institution. P111 Rhinoscleroma: A Case Report and Update on Medical and Surgical Management Casey Drawert (presenter); C Blake Simpson, MD; Ruben Velazquez, MD; Howard S McGuff, DDS San Antonio TX; San Antonio TX; San Antonio TX; San Antonio TX

Objectives: Rhinoscleroma is a chronic, progressive, granulomatous infection caused by Klebsiella rhinoscleromatis. The bacteria can infect the upper and/or lower airways, with the sinonasal cavity being affected 95%-100% of the time. We present the case of a 42-year-old Hispanic man who presented with Stage 3 rhinoscleroma, resulting in nasopharyngeal, glottic, and subglottic stenosis. Methods: The patient was taken to the operating room for direct microlaryngoscopy. A posterior cordotomy of the left vocal fold and laser radial incisions/dilation of the subglottis were performed along with topical application of Mitomycin-C. Results: Biopsies of the nasopharygeal and subglottic lesions showed inspissated mucin with foamy histiocytes, gram negative bacilli, and acute and chronic inflammation with fibrosis. Cultures were positive for Klebsiella rhinoscleromatis, sensitive to gatifloxacin. These pathological findings were consistent with Stage 3 rhinoscleroma. The patient was treated with a 6-month course of gatifloxacin. Purulent rhinorrhea and airway difficulties were improved at 6 weeks and resolved at 6 months. Conclusion: We report a case of synchronous rhinoscleromatous lesions. A combination treatment of surgical laser debridement, Mitomycin-C and long-term fluoroquinolones appears to be effective in treating this condition. There are 3 stages of rhinoscleroma and with prompt recognition and early treatment, the natural history of the disease can be

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Otolaryngology– Head and Neck Surgery August 2004