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CT for nasal septal deviation: Is turbinate surgery necessary in septoplasty?
Otolaryngology– Head and Neck Surgery Volume 131 Number 2
P112 A Rare Case Report about Noma or Cancrum Oris Occurring in a Neutropenic Patient Kshitij V Majmundar, MD (presenter); Andrew J Heller, MD Richmond VA; Midlothian VA
Objectives: To discuss the etiology, diagnosis, and management of Noma, a rare and devastating disease of the facial tissues Methods: Case report Results: The authors describe a case of Noma in a 50year-old female who developed a gangrenous oro-facial lesion of her left face after cytotoxic chemotherapy for acute lymphoblastic leukemia. The patient was treated with broadspectrum intraveous antibiotics and extensive debridement of necrotic tissues followed by reconstruction of the large fullthickness defect. Conclusion: Noma, or cancrum oris, is an uncommon ailment not well known in Europe or North America. Without treatment, the mortality rate of this dehumanizing infectious disease is 70%-90%. Early intervention and prevention of noma lesions in immunocompromised adults by optimizing their nutritional status, encouraging oral hygiene, maintaining adequate hydration, and closely monitoring intraoral lesions seems to be the key. Early lesions, such as acute necrotizing ulcerative gingivitis (ANUG), should be treated aggressively with oral hygiene, antibiotics (intravenous penicillin), and conservative debridement of necrotic tissues in addition to addressing the patient’s hydration and nutritional status. If uncontrolled, Noma can destroy large amounts of both hard and soft tissues of the face which can present a formidable reconstructive challenge. P113 Endolymphatic Sac Decompression with and without Shunt for Vertigo and Hearing Sensitivity Rafael E Quinonez, MD (presenter); Robert E King, MD; Sam J Marzo, MD; John P Leonetti, MD Maywood IL; Oak Park IL; Maywood IL; Maywood IL
Objectives: Endolymphatic sac decompression (ELSD) is a surgical alternative for those patients with Meniere’s disease that are resistant to medical therapy. This safe, nondestructive surgical option can be performed with and without shunt placement. The present retrospective study investigates the long-term efficacy of this surgical treatment with and without shunt placement.
P277
Methods: Seventy-five patients who underwent ELSD with or without shunts were included in the present investigation based on availability of pre- and postoperative data. Four-tone average using .5, 1, 2, and 3 kHz and speech discrimination scores were used to compare hearing pre- and postoperatively. Postoperative vertigo was rated as absent, decreased, unchanged, and increased when compared to preoperative vertigo. The preoperative data were obtained within 6 months prior to surgery and postoperative data within 6 –24 months following surgery. Results: No improvement in hearing sensitivity was found postoperatively in either study group and no statistical difference was measured in hearing sensitivity between both groups. Vertigo was absent in 55%, decreased in 13%, unchanged in 15%, and increased in 17% of those patients not receiving a shunt. Vertigo in contrast was absent in 50%, decreased in 29%, unchanged in 14%, and increased in 7% of those patients with shunts. Conclusion: These data suggest no benefit with regard to hearing. However, the data do suggest that postoperative vertigo in the shunt group is better controlled.
P114 CT for Nasal Septal Deviation: Is Turbinate Surgery Necessary in Septoplasty? Sung Won Kim (presenter); Beom Cho Jun, MD; Hyun Jin Park, MD; Soo Whan Kim, MD; Jin Hee Cho, MD; He Ro Yoon, MD Seoul South Korea; Uijungbu-Kyongg South Korea; Seoul Japan; Seoul South Korea; Seoul South Korea; Seoul South Korea
Objectives: Septoplasty with or without turbinate surgery is performed by many otorhinolaryngologists. However, the surgical methods largely rely on clinical judgment alone. The purpose of this study is to investigate the correlation between deviated nasal septum and inferior turbinate with compensatory hypertrophy on paranasal sinus computed tomography and to suggest a guideline for septal and turbinate surgery. Methods: Computerized tomography scans of paranasal sinus of 20 patients with nasal septal deviation and compensatory hypertrophied inferior turbinate were taken and reviewed. Measurements of angle of septal deviation, thickness of mucosa and conchal bone, and projection angle of inferior turbinate using PACS (picture archiving and communicating system) were obtained. Three-dimensional reconstruction images were obtained by surface rendering technique on the same patients using a software with personal computer. Each measurement was compared to that of opposite side of nasal cavity. Results: The inferior turbinate of the concave side underwent a increase in thickness and projection angle and manifested a significant expansion of volume (P ⬍ 0.05, wilcoxon signed rank test), but the correlation between deviated septal
POSTERS
halted. The advantages of fluoroquinolones over traditional antibiotic treatment for this condition (tetracycline) include low incidence of side effects, once daily dosing and concentration within the macrophages, the region of bacterial replication. When surgical treatment is necessary, stenosis can be effectively managed with CO2 laser treatments and Mitomycin-C.
Scientific Posters
Scientific Posters
angles and volumes of inferior turbinate was not significant (P ⬎ 0.05, spearman test). Conclusion: Septoplasty and concomitant inferior turbinate surgery that manipulates conchal bone and soft tissue of turbinate is necessary for the patients with a complaint of nasal obstruction. The data gathered using 3-D reconstruction images in this study are of importance to the decision-making process of nasal surgery including the turbinates. P115 Cushing’s Syndrome Secondary to Intralesional Steroid Injections of Keloids Michelle Ferdinand Liu, MD (presenter); Myron W Yencha, Jr, MD Portsmouth VA; Chesapeake VA
Objectives: Iatrogenic Cushing’s syndrome has been described as resulting from intranasal steroid inhalation or the altered metabolism of certain medications. Intralesional steroids, the adjunctive treatment of choice used perioperatively for keloid scars, is another potential cause of Cushing’s syndrome which has rarely been reported in the English literature. A patient is described who presented with severe weight gain, striae, moon-face, hirsutism, and amenorrhea within 3 months after a series of intralesional steroid injections following the excision of multiple keloids, including one in the postauricular region. Methods: We present a case report of Cushing’s syndrome secondary to multiple 40 mg triamcinolone acetonide injections after keloid excision. Results: Cushingoid features resolved within 12 months after discontinuing intralesional steroid injections. Conclusion: The rare complication of Cushing’s syndrome following intralesional injection of steroids is displayed in this adult patient who was treated for multiple keloid scars. This case is significant because of the extensive use of steroids in the treatment of keloids as well as other lesions. To avoid the risk of systemic effects, doses and intervals should be taken into consideration as well as the size and number of keloids selected for treatment. P116 Primary Treatment of Thin Subglottic Stenosis with Laser Excision and Topical Mitomycin C James Joseph Klemens, MD (presenter); Fuad M Baroody, MD Chicago IL; Chicago IL
Objectives: Subglottic stenosis (SGS) is the most common complication of endotracheal intubation in the pediatric age group, with an incidence of approximately 2%. These patients require numerous procedures, and the poor success rates are reflected by the multitude of treatment strategies that are available. Mitomycin C, a chemotherapeutic agent has been used topically to prevent scar formation but never as a primary treatment.
Methods: A retrospective review of 3 patients tracheotomized for thin (1 cm long stenotic segment) subglottic stenosis who were treated primarily with serial laser excision and application of mitomycin C was performed. The charts were reviewed for initial Cotton grade, Cotton grade after each procedure, number of procedures required for decannulation, time from first operation until decannulation, operation performed, and concentration of mitomycin C used. Results: Two patients with an initial Cotton grade III were decannulated, one 9 months after tracheotomy and the other 1 year after tracheotomy, with grade I stenoses. These patients required 5 and 6 procedures, respectively. The third patient had an initial Cotton grade II and was decannulated 9 months after tracheotomy with a grade I stenosis after 3 procedures. None of the patients had any complications. Conclusion: Although laser excision and dilation of subglottic stenosis has historically failed due to restenosis, use of mitomycin C may improve the outcome in selected patients. Patients who require tracheotomy for thin segment (less than 1 cm) stenosis may benefit from this minimally invasive treatment.
P117 The Surgical Management of Otitis Media with Effusion in Childhood Catherine Spinou (presenter) Glasgow United Kingdom
Objectives: To assess the surgical management for otits media with efusion in childhood,within the North Argyll and Clyde region in Scotland. Methods: A prospective study was designed to assess the management of the condition.The study was conducted over 5 years, between 1996 and 2001. During this time 384 procedures were carried out on 296 patients. Sixty-one patients underwent more than one procedures. Results: The age of the patients varied from 2 to 16 years with a mean of 6 and a median of 6. Unilateral grommet insertion was performed in 80 patients (27%). Within this group the need for a second operation for contra lateral grommet insertion 3 to 6 months postoperatively was common. Eighteen patients (8%) had a worse postoperative PTA than their preoperative one. In 12 (5%) the PTA remained unchanged. The rest of the patients showed an improvement varying from 5 to 50 db with a mean of 14 db and a median of 15 db. Complications following the procedures were noticed in 10 patients (3.4%) and these included 3 patients with perforations following grommet insertion and 6 patients with recurrent acute otitis media and discharge. Conclusion: Although grommet insertion is a quick and safe procedure, it is not completely without risks or complications. The authors recommend that otolaryngologists in Scotland follow the SIGN guidelines.The clinicians could also consider close observation with repeated audiograms and
POSTERS
P278
Otolaryngology– Head and Neck Surgery August 2004
P112 A Rare Case Report about Noma or Cancrum Oris Occurring in a Neutropenic Patient Kshitij V Majmundar, MD (presenter); Andrew J Heller, MD Richmond VA; Midlothian VA
Objectives: To discuss the etiology, diagnosis, and management of Noma, a rare and devastating disease of the facial tissues Methods: Case report Results: The authors describe a case of Noma in a 50year-old female who developed a gangrenous oro-facial lesion of her left face after cytotoxic chemotherapy for acute lymphoblastic leukemia. The patient was treated with broadspectrum intraveous antibiotics and extensive debridement of necrotic tissues followed by reconstruction of the large fullthickness defect. Conclusion: Noma, or cancrum oris, is an uncommon ailment not well known in Europe or North America. Without treatment, the mortality rate of this dehumanizing infectious disease is 70%-90%. Early intervention and prevention of noma lesions in immunocompromised adults by optimizing their nutritional status, encouraging oral hygiene, maintaining adequate hydration, and closely monitoring intraoral lesions seems to be the key. Early lesions, such as acute necrotizing ulcerative gingivitis (ANUG), should be treated aggressively with oral hygiene, antibiotics (intravenous penicillin), and conservative debridement of necrotic tissues in addition to addressing the patient’s hydration and nutritional status. If uncontrolled, Noma can destroy large amounts of both hard and soft tissues of the face which can present a formidable reconstructive challenge. P113 Endolymphatic Sac Decompression with and without Shunt for Vertigo and Hearing Sensitivity Rafael E Quinonez, MD (presenter); Robert E King, MD; Sam J Marzo, MD; John P Leonetti, MD Maywood IL; Oak Park IL; Maywood IL; Maywood IL
Objectives: Endolymphatic sac decompression (ELSD) is a surgical alternative for those patients with Meniere’s disease that are resistant to medical therapy. This safe, nondestructive surgical option can be performed with and without shunt placement. The present retrospective study investigates the long-term efficacy of this surgical treatment with and without shunt placement.
P277
Methods: Seventy-five patients who underwent ELSD with or without shunts were included in the present investigation based on availability of pre- and postoperative data. Four-tone average using .5, 1, 2, and 3 kHz and speech discrimination scores were used to compare hearing pre- and postoperatively. Postoperative vertigo was rated as absent, decreased, unchanged, and increased when compared to preoperative vertigo. The preoperative data were obtained within 6 months prior to surgery and postoperative data within 6 –24 months following surgery. Results: No improvement in hearing sensitivity was found postoperatively in either study group and no statistical difference was measured in hearing sensitivity between both groups. Vertigo was absent in 55%, decreased in 13%, unchanged in 15%, and increased in 17% of those patients not receiving a shunt. Vertigo in contrast was absent in 50%, decreased in 29%, unchanged in 14%, and increased in 7% of those patients with shunts. Conclusion: These data suggest no benefit with regard to hearing. However, the data do suggest that postoperative vertigo in the shunt group is better controlled.
P114 CT for Nasal Septal Deviation: Is Turbinate Surgery Necessary in Septoplasty? Sung Won Kim (presenter); Beom Cho Jun, MD; Hyun Jin Park, MD; Soo Whan Kim, MD; Jin Hee Cho, MD; He Ro Yoon, MD Seoul South Korea; Uijungbu-Kyongg South Korea; Seoul Japan; Seoul South Korea; Seoul South Korea; Seoul South Korea
Objectives: Septoplasty with or without turbinate surgery is performed by many otorhinolaryngologists. However, the surgical methods largely rely on clinical judgment alone. The purpose of this study is to investigate the correlation between deviated nasal septum and inferior turbinate with compensatory hypertrophy on paranasal sinus computed tomography and to suggest a guideline for septal and turbinate surgery. Methods: Computerized tomography scans of paranasal sinus of 20 patients with nasal septal deviation and compensatory hypertrophied inferior turbinate were taken and reviewed. Measurements of angle of septal deviation, thickness of mucosa and conchal bone, and projection angle of inferior turbinate using PACS (picture archiving and communicating system) were obtained. Three-dimensional reconstruction images were obtained by surface rendering technique on the same patients using a software with personal computer. Each measurement was compared to that of opposite side of nasal cavity. Results: The inferior turbinate of the concave side underwent a increase in thickness and projection angle and manifested a significant expansion of volume (P ⬍ 0.05, wilcoxon signed rank test), but the correlation between deviated septal
POSTERS
halted. The advantages of fluoroquinolones over traditional antibiotic treatment for this condition (tetracycline) include low incidence of side effects, once daily dosing and concentration within the macrophages, the region of bacterial replication. When surgical treatment is necessary, stenosis can be effectively managed with CO2 laser treatments and Mitomycin-C.
Scientific Posters
Scientific Posters
angles and volumes of inferior turbinate was not significant (P ⬎ 0.05, spearman test). Conclusion: Septoplasty and concomitant inferior turbinate surgery that manipulates conchal bone and soft tissue of turbinate is necessary for the patients with a complaint of nasal obstruction. The data gathered using 3-D reconstruction images in this study are of importance to the decision-making process of nasal surgery including the turbinates. P115 Cushing’s Syndrome Secondary to Intralesional Steroid Injections of Keloids Michelle Ferdinand Liu, MD (presenter); Myron W Yencha, Jr, MD Portsmouth VA; Chesapeake VA
Objectives: Iatrogenic Cushing’s syndrome has been described as resulting from intranasal steroid inhalation or the altered metabolism of certain medications. Intralesional steroids, the adjunctive treatment of choice used perioperatively for keloid scars, is another potential cause of Cushing’s syndrome which has rarely been reported in the English literature. A patient is described who presented with severe weight gain, striae, moon-face, hirsutism, and amenorrhea within 3 months after a series of intralesional steroid injections following the excision of multiple keloids, including one in the postauricular region. Methods: We present a case report of Cushing’s syndrome secondary to multiple 40 mg triamcinolone acetonide injections after keloid excision. Results: Cushingoid features resolved within 12 months after discontinuing intralesional steroid injections. Conclusion: The rare complication of Cushing’s syndrome following intralesional injection of steroids is displayed in this adult patient who was treated for multiple keloid scars. This case is significant because of the extensive use of steroids in the treatment of keloids as well as other lesions. To avoid the risk of systemic effects, doses and intervals should be taken into consideration as well as the size and number of keloids selected for treatment. P116 Primary Treatment of Thin Subglottic Stenosis with Laser Excision and Topical Mitomycin C James Joseph Klemens, MD (presenter); Fuad M Baroody, MD Chicago IL; Chicago IL
Objectives: Subglottic stenosis (SGS) is the most common complication of endotracheal intubation in the pediatric age group, with an incidence of approximately 2%. These patients require numerous procedures, and the poor success rates are reflected by the multitude of treatment strategies that are available. Mitomycin C, a chemotherapeutic agent has been used topically to prevent scar formation but never as a primary treatment.
Methods: A retrospective review of 3 patients tracheotomized for thin (1 cm long stenotic segment) subglottic stenosis who were treated primarily with serial laser excision and application of mitomycin C was performed. The charts were reviewed for initial Cotton grade, Cotton grade after each procedure, number of procedures required for decannulation, time from first operation until decannulation, operation performed, and concentration of mitomycin C used. Results: Two patients with an initial Cotton grade III were decannulated, one 9 months after tracheotomy and the other 1 year after tracheotomy, with grade I stenoses. These patients required 5 and 6 procedures, respectively. The third patient had an initial Cotton grade II and was decannulated 9 months after tracheotomy with a grade I stenosis after 3 procedures. None of the patients had any complications. Conclusion: Although laser excision and dilation of subglottic stenosis has historically failed due to restenosis, use of mitomycin C may improve the outcome in selected patients. Patients who require tracheotomy for thin segment (less than 1 cm) stenosis may benefit from this minimally invasive treatment.
P117 The Surgical Management of Otitis Media with Effusion in Childhood Catherine Spinou (presenter) Glasgow United Kingdom
Objectives: To assess the surgical management for otits media with efusion in childhood,within the North Argyll and Clyde region in Scotland. Methods: A prospective study was designed to assess the management of the condition.The study was conducted over 5 years, between 1996 and 2001. During this time 384 procedures were carried out on 296 patients. Sixty-one patients underwent more than one procedures. Results: The age of the patients varied from 2 to 16 years with a mean of 6 and a median of 6. Unilateral grommet insertion was performed in 80 patients (27%). Within this group the need for a second operation for contra lateral grommet insertion 3 to 6 months postoperatively was common. Eighteen patients (8%) had a worse postoperative PTA than their preoperative one. In 12 (5%) the PTA remained unchanged. The rest of the patients showed an improvement varying from 5 to 50 db with a mean of 14 db and a median of 15 db. Complications following the procedures were noticed in 10 patients (3.4%) and these included 3 patients with perforations following grommet insertion and 6 patients with recurrent acute otitis media and discharge. Conclusion: Although grommet insertion is a quick and safe procedure, it is not completely without risks or complications. The authors recommend that otolaryngologists in Scotland follow the SIGN guidelines.The clinicians could also consider close observation with repeated audiograms and
POSTERS
P278
Otolaryngology– Head and Neck Surgery August 2004