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OtolaryngologyHead and Neck Sur~lery August T999
Scientific Posters
peaks between 2 consecutive harmonic peaks in the power spectrum in some pathologic voices, especially in cases of laryngeal polyp or Reinke's edema. These lower peaks are termed subharmonics. This study investigates the presence of subharmonics in the power spectrum of 115 pathologic voices. Methods: We studied 115 subjects with pathologic voices. Each person was asked to phonate the vowel sound/ae/at a comfortable speaking level. A steady 3-second portion of each sustained vowel was selected for analysis. The power spectrum of the acoustic signal was then calculated by fast Fourier transformation. Fundamental frequency and existence and number and frequency of subharmonics were determined. Frequency of subharmonics was defined by the frequency interval between a high peak of a harmonic and the adjacent lower peak of a subharmonic. Jitter and shimmer were calculated from the acoustic signals and expressed as a percentage. Results: Subharmonics were identified in 36 cases (31.3%) of 115 pathologic voices using spectrum analysis (14 laryngeal polyps, 16 Reinke's edema, 2 plicae ventricularis, 1 prolapse of the ventricle, 2 hyperfunctional dysphonia, and 1 spasmodic dysphonia). In 1 case 2 subharmonics were identified. In 35 of the 36 cases, 1 subharmonic was identified; the frequency of the subharmonic was exactly half of the fundamental frequency. Acoustic analysis of jitter and shimmer was undertaken in the 36 patients who had subhannonics in spectrum analysis. In the 36 cases, 13 patients had normal jitter and shimmer. Conclusion: Rough voice has been acoustically characterized by analysis of jitter and shimmer in a sustained vowel sound. However, several pathologic voices with normal jitter and shimmer exist. In these patients subharmonics were seen in spectrum analysis. The low frequency of subharmonics are causing the perceptual judgment of hoarseness. Subharmonic analysis provides an objective evaluation of rough voices and is recommended when acoustic assessment of rough voice is required.
patients with low-flow AVMs of the head and neck refractory to conservative treatment who underwent an innovative treatment using the Nd:YAG laser for interstitial photocoagulation with intraoperative ultrasound guidance. Methods: Two patients are presented (age range 6-16 years) who were diagnosed with low-flow arteriovenous malformations of the head and neck (palate, cheek) by previous imaging studies. All had failed previous conservative treatment measures, most commonly embolization, and all lesions were unamendable to primary resection secondary to expected significant morbidity. Patients underwent serial interstitial photocoagulation using the fiber-based Nd:YAG laser with intraoperative ultrasound guidance. This was accomplished by introducing the laser fiber percutaneously/intraorally with an angiocath and delivering variable amounts (600 to 10,000 J) of laser energy under real-time Doppler ultrasound visualization. Results: All patients experienced regression of their vascular lesions as confirmed by physical examination. One patient who had multiple life-threatening intraoral hemorrhages preoperatively experienced complete resolution of symptoms after 3 treatments. Patients with cosmetic deformity voiced significant, subjective improvement in appearance. Average follow-up is more than 1 year. Intraoperative postprocedure ultrasound showed near-complete cessation of vascular lesion blood flow, as compared with preprocedure images. The procedures were easy to perform and well tolerated, with all patients being discharged within 24 hours. Conclusion: Interstitial Nd:YAG laser photocoagulation offers the otolaryngologist a therapeutic alternative in refractory, unresectable arteriovenous malformations. Although multiple treatments may be required, the procedure is effective, simply performed, and well tolerated by all age groups.
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Endoscopic Approach to Subperiosteal Abscess PAUL E LOMEO DO; JOHN EDWARD MCDONALD DO; JUDITH L FINNEMAN LPN-CST; Muskegon MI
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Interstitial Laser Therapy for Vascular Malformations in Children SCOTr E BRIETZKE MD; ERIC A MAIR MD; CHRISTOPHER KLEM MD; DANIEL J THEBERGEDDS; Gaithersburg MD; Rockville MD; Washington DC; Washington DC
Objectives: Arteriovenous malformations (AVMs) are vascular lesions consisting of fistulous communications between the arterial and venous systems. Unlike the more common congenital hemangioma, AVMs usually do not follow a benign course ending with spontaneous resolution. They can have devastating consequences including recurrent life-threatening hemorrhage, high-output heart failure, and superficial cosmetic deformity. The primary surgical therapy has been excision. Recurrence is common. We present a case series of
Objectives: A subperiosteal abscess is a serious complication from sinusitis. This abscess develops between the orbital wall and periosteal lining. Most commonly, these abscesses are treated with intravenous antibiotics and an external approach to drain the abscess. In our institution, endoscopic drainage of a subperiosteal abscess is the treatment of choice. Methods: All patients presented with acute sinusitis, unilateral proptosis, decreased vision, and severe facial pain. A CT scan revealed a subperiosteal abscess. The patients were started on intravenous antibiotics. Sinus endoscopy was performed, and under direct visualization, the abscess was drained. Results: Sinus endoscopy was used to drain subperiosteal abscesses with no complications. All symptoms of facial pain, proptosis, and decreased vision resolved the next day. The
OtolaryngologyHead and Neck Surgery Volume 121 N u m b e r 2
procedure took 30 to 60 minutes with minimal bleeding and no ocular damage. Conclusion: Subperiosteal abscess occurs in approximately 10% to 15% of all acute sinusitis cases. The lreatment consists of intravenous antibiotics and drainage to prevent ocular and cranial injury. Endoscopic treatment of subperiosteal abscess has less morbidity and better cosmetic effect than the external approach.
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Lemierre's Syndrome: Necrobacillosls and Postanginal Sepsis STEPHEN P H CLYNE MS; WILLIAM F MCGUIRT JR MD; BRADFORD WARREN HOLLAND MD; Winston-Salem NC
Objectives: Lemierre's syndrome is characterized by thrombophlebitis of the internal jugular vein as a complication of anaerobic sepsis from an intraoral infection. Necrobacillosis is the term used to describe Lemierre's syndrome when caused by the bacillus Fusobacterium necrophorum. Rare cases of Lemierre's syndrome have been reported in the postantibiotic era, but blood cultures have seldom isolated this organism. Methods: We report a case of classic Lemierre's syndrome in a 15-year-old girl who developed necrobacillosis as a complication of pharyngitis. Blood cultures grew F necrophorum. The patient developed further complications from this disease, including pulmonary effusions and decreased mental status. Results: The patient was treated conservatively with intravenous antibiotics and without anticoagulation. Although critically ill, she was able to completely recover from this illness without suffering permanent morbidity. We review the clinical considerations and treatment options for this case and Lemierre's syndrome in general. Conclusion: Although quite rare, Lemierre's syndrome and necrobacillosis represent life-threatening complications of common clinical conditions seen by the general otolaryngologist. Familiarity with the pathophysiology and etiology of this disease will aid in its treatment. Advances in diagnostic imaging and interventional technologies bring new potential therapies for this old-time disease.
105 Unique Case of Simultaneous Laryngocele and Saccular
Cyst CARLTON J ZDANSKI MD; CHAPMAN T MCQUEEN MD; WILLIAM W SHOCKLEY MD; Chapel Hill NC; Burlington NC; Chapel Hill NC
Objectives: Laryngoceles and saccular cysts are rare benign cysts of the larynx that may lead to airway obstruction. Rare reports of bilateral laryngoceles may be found in the literature. We present the unique case of a simultaneous laryngocele and saccular cyst. Methods: The chart of a 45-year-old woman with the
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simultaneous presentation of a left laryngeal saccular cyst and a right internal and external laryngocele causing progressive airway obstruction was reviewed. The radiographs, pathology photomicrographs, and intraoperative photographs have been prepared for presentation. The current literature regarding etiology, pathophysiology, diagnosis, and treatment was reviewed. Results: A search of the literature revealed this to be the first reported case of simultaneous laryngocele and saccular cyst. After CT and microdirect laryngoscopy, the patient underwent transcervical excision of the saccular cyst and laryngocele with tracheotomy for airway protection. Conclusion: This is the first reported case of simultaneous laryngocele and saccular cyst. The management of the case is reviewed. In addition, the current literature regarding etiology, pathophysiology, diagnosis, and treatment is also reviewed and presented.
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Nasal Septal Abscess Due to Dental Prosthesis CIRIACO CRISTOVAO TAVARES ATHERINO MD; ROBERTO CAMPOS MEIRELLESPHD; LUCIANO AUGUSTO SOUZA MOREIRA MD; Rio de Janeiro Brazil; Rio de Janeiro Brazil; Juiz de Fora Brazil
Objectives: Nasal septal abscess (NSA) is not commonly seen and may be due to several factors including past surgery and trauma. In 1982, da Silva et al reported 2 cases of NSA with dental infection as origin. In the present study, 3 cases of NSA due to dental prosthesis are presented, and problems on diagnosis and surgical approaches are discussed. Methods: Clinical aspects, diagnosis, and treatment of 3 cases of NSA due to dental prosthesis seen in the last 8 years are presented. They had no history of past facial surgery or trauma, and other causes of NSA were excluded. All patients underwent surgical drainage by different techniques followed by culture. Results: In all 3 cases, anarnnesis, physical examination, and CT scan made a precise nasal septal abscess diagnosis. Etiology was assessed by exclusion after clinical history and blood studies. Posterior orthodontic examination reinforced the prosthesis origin. Conclusion: NSA is uncommon. Dental origin has been implicated only once. Dental prosthesis as origin was not seen in literature. It is important for the otorhinolaryngologist n o t only to recognize the NSA and proceed to a precise surgery technique but also to consider its possible etiologies, such as dental prosthesis.
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Unusual Presentations of Cat Scratch Disease ALEXANDER G CHIU MD; CHRISTOPHER P MESICK MD; DAVID A HECHT MD; SUZE~E K MIKULA MD; Bethesda MD; Falls Church VA; Arlington VA; Alexandria VA