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Head and neck complications of central venous catheters
Scientific Posters
Objectives: Lipoid proteinosis, also known as UrbachWiethe’s disease, is a very rare autosomal recessive disorder characterized by infiltration of hyaline material into the skin, oral cavity, larynx, and other organs. It develops in infancy and the larynx is involved to a severe degree with nodules in the epiglottis and vocal cords. The purpose of this study is to report cases of a rare disease. Methods: Five patients with hoarseness were analyzed by indirect videolaryngoscopy and underwent microlaryngoscopy with biopsy of the laryngeal mucosa and skin lesions. All patients were treated clinically with etritinate. Results: The diagnosis was confirmed by the anatomopathological examination showing hyaline glicoproteic material in all cases. The oral treatment with etritinate had a good clinical response. The follow-up, over 15 years, revealed effective drug results in controlling clinical symptoms. Conclusion: The clinical treatment has demonstrated an efficient palliative control of the symptoms. It is of interest to the otolaryngologist to have knowledge of Urbach-Wiethe’s disease because of its respiratory tract involvement.
P136 Inferior Uvulectomy in Obstructive Sleep Apnea Andrew J Lerrick MD (presenter); David Kent Steffey MPAS Chicago IL; Chicago IL
Objectives: Uvulopalatopharyngoplasty (UPPP) is the preferred surgical technique used to treat obstructive sleep apnea. UPPP includes uvula excision, estimated by any one of a number of methods, such as palpation of the posterior wall through the soft palate to determine the level at which it no longer makes contact, or by transecting the soft palate at some predetermined site regardless of the palatal arch’s characteristics or its proximity to the posterior wall. One consequence of removing too much tissue is velopharyngeal insufficiency; excising too little tissue causes residual obstruction. Methods: Transection of the muscularis uvulae disrupts the contiguous fibers of the tensor veli palatini and the levator veli palatini, alters soft palate tension, elevation, and drawback, and affects eustachian tube dilation, potentially disrupting function from the oropharynx to the middle ear space. Results: To minimize morbidity caused by uvulectomy, we remove a greater proportion of tissue in the lateral aspect of the faucial arch, plicate the postero-lateral soft-tissue laterally, and create through-and-through parauvular fissures, which appears to elongate the uvula. To correct this distortion we perform a partial uvulectomy. The uvula is retracted inferiorly and trimmed at a 30° angle using several sweeping motions on each side with a needle-tip cautery set at 15 to 20 watts. An “arrowhead” tip is created. If too much uvula remains, the same steps are repeated until the desired length is achieved. Conclusion: Due to its dependent position, the tip assumes
a rounded contour as it heals. With the soft palate aponeurosis preserved, the foreshortened uvula retains its primary functions. P137 Head and Neck Complications of Central Venous Catheters Brian W Downs MD (presenter); Brett E Dorfman MD Chapel Hill NC; Raleigh NC
Objectives: To familiarize practitioners with the head and neck complications of central venous catheterization. Methods: A single case was reported and a review of the medical literature was performed. Results: Complications of central venous catheters can occur in up to 10% of patients who undergo such procedures. Sequelae in the head and neck can range from minor to life-threatening, with airway obstruction and vascular injury being the most severe. Our patient underwent placement of an internal jugular vein catheter prior to resection of a hemangioblastoma. She experienced progressive airway obstruction at the level of the supraglottis and neck swelling which ultimately required urgent tracheotomy. Her airway edema gradually resolved with conservative management and she was decannulated successfully several days later. The source of her airway obstruction appeared to be mass effect from local intravenous fluid extravasation. Similarly, arterial injury can result in hematoma with either immediate or delayed airway obstruction, depending on the magnitude of the injury. Conclusion: Intravenous fluid extravasation resulting in airway obstruction is one of the possible head and neck complications of central venous catheterization. Only two other such cases have been reported in the literature, one featuring supraglottic obstruction and one featuring tracheal obstruction. Other head and neck complications include hematoma and arterial injury. Otolaryngologists should be familiar with central venous catheter complications as they may be called to render definitive treatment. P138 The Width of Nasal Septal Cartilage Adam T Ross MD (presenter); Daniel Becker MD Philadelphia PA; Philadelphia PA
Objectives: Cartilage scoring techniques have long been used to affect the shape of cartilage in restoring normal anatomy. This practice is commonly performed on nasal septal cartilage as an adjunct to nasal procedures such as septorhinoplasty. Although there are studies in the literature describing the anatomic properties of the nasal septum as a whole, we found no study that addresses the dimensional characteristics and variability of nasal septal cartilage as its own entity. Methods: A two-pronged approach was taken to define the
POSTERS
P256
Otolaryngology– Head and Neck Surgery August 2003
Objectives: Lipoid proteinosis, also known as UrbachWiethe’s disease, is a very rare autosomal recessive disorder characterized by infiltration of hyaline material into the skin, oral cavity, larynx, and other organs. It develops in infancy and the larynx is involved to a severe degree with nodules in the epiglottis and vocal cords. The purpose of this study is to report cases of a rare disease. Methods: Five patients with hoarseness were analyzed by indirect videolaryngoscopy and underwent microlaryngoscopy with biopsy of the laryngeal mucosa and skin lesions. All patients were treated clinically with etritinate. Results: The diagnosis was confirmed by the anatomopathological examination showing hyaline glicoproteic material in all cases. The oral treatment with etritinate had a good clinical response. The follow-up, over 15 years, revealed effective drug results in controlling clinical symptoms. Conclusion: The clinical treatment has demonstrated an efficient palliative control of the symptoms. It is of interest to the otolaryngologist to have knowledge of Urbach-Wiethe’s disease because of its respiratory tract involvement.
P136 Inferior Uvulectomy in Obstructive Sleep Apnea Andrew J Lerrick MD (presenter); David Kent Steffey MPAS Chicago IL; Chicago IL
Objectives: Uvulopalatopharyngoplasty (UPPP) is the preferred surgical technique used to treat obstructive sleep apnea. UPPP includes uvula excision, estimated by any one of a number of methods, such as palpation of the posterior wall through the soft palate to determine the level at which it no longer makes contact, or by transecting the soft palate at some predetermined site regardless of the palatal arch’s characteristics or its proximity to the posterior wall. One consequence of removing too much tissue is velopharyngeal insufficiency; excising too little tissue causes residual obstruction. Methods: Transection of the muscularis uvulae disrupts the contiguous fibers of the tensor veli palatini and the levator veli palatini, alters soft palate tension, elevation, and drawback, and affects eustachian tube dilation, potentially disrupting function from the oropharynx to the middle ear space. Results: To minimize morbidity caused by uvulectomy, we remove a greater proportion of tissue in the lateral aspect of the faucial arch, plicate the postero-lateral soft-tissue laterally, and create through-and-through parauvular fissures, which appears to elongate the uvula. To correct this distortion we perform a partial uvulectomy. The uvula is retracted inferiorly and trimmed at a 30° angle using several sweeping motions on each side with a needle-tip cautery set at 15 to 20 watts. An “arrowhead” tip is created. If too much uvula remains, the same steps are repeated until the desired length is achieved. Conclusion: Due to its dependent position, the tip assumes
a rounded contour as it heals. With the soft palate aponeurosis preserved, the foreshortened uvula retains its primary functions. P137 Head and Neck Complications of Central Venous Catheters Brian W Downs MD (presenter); Brett E Dorfman MD Chapel Hill NC; Raleigh NC
Objectives: To familiarize practitioners with the head and neck complications of central venous catheterization. Methods: A single case was reported and a review of the medical literature was performed. Results: Complications of central venous catheters can occur in up to 10% of patients who undergo such procedures. Sequelae in the head and neck can range from minor to life-threatening, with airway obstruction and vascular injury being the most severe. Our patient underwent placement of an internal jugular vein catheter prior to resection of a hemangioblastoma. She experienced progressive airway obstruction at the level of the supraglottis and neck swelling which ultimately required urgent tracheotomy. Her airway edema gradually resolved with conservative management and she was decannulated successfully several days later. The source of her airway obstruction appeared to be mass effect from local intravenous fluid extravasation. Similarly, arterial injury can result in hematoma with either immediate or delayed airway obstruction, depending on the magnitude of the injury. Conclusion: Intravenous fluid extravasation resulting in airway obstruction is one of the possible head and neck complications of central venous catheterization. Only two other such cases have been reported in the literature, one featuring supraglottic obstruction and one featuring tracheal obstruction. Other head and neck complications include hematoma and arterial injury. Otolaryngologists should be familiar with central venous catheter complications as they may be called to render definitive treatment. P138 The Width of Nasal Septal Cartilage Adam T Ross MD (presenter); Daniel Becker MD Philadelphia PA; Philadelphia PA
Objectives: Cartilage scoring techniques have long been used to affect the shape of cartilage in restoring normal anatomy. This practice is commonly performed on nasal septal cartilage as an adjunct to nasal procedures such as septorhinoplasty. Although there are studies in the literature describing the anatomic properties of the nasal septum as a whole, we found no study that addresses the dimensional characteristics and variability of nasal septal cartilage as its own entity. Methods: A two-pronged approach was taken to define the
POSTERS
P256
Otolaryngology– Head and Neck Surgery August 2003