- Email: [email protected]
International symposia: Rhinoplasty for latin noses
no reports of mitomycin toxicicity have been reported in the otolaryngology literature, the ophthalmologic literature has documented serious, vision-threatening complications resulting from the use of topical mitomycin-C. The purpose of this study is to report complications related to mitomycin-C use in the treatment of glottic and subglottic stenosis. Risk factors associated with these complications are identified. Methods: A retrospective chart review of all patients treated by the senior author for glottic, subglottic, and tracheal stenosis during a 4-year period was performed to determine incidence of complications. Variables studied were: patient age and gender, location and severity of stenosis, medical comorbidities, length of procedure, postoperative instrumentation of the airway, and mitomycin-C concentration. Results: Sixty-six cases of adjuvant topical mitomycin-C use following laser laryngoscopic treatment and dilation for upper airway stenosis were identified in a total of 45 patients. Complications due to local toxicity of mitomycin-C occurred in 4 patients of 66 (or 6%), manifested by accumulation of fibrinous debris at the operative site, resulting in partial airway obstruction, and the need for emergent airway intervention. A significantly higher percentage of complications occurred when supersaturated mitomycin-C (10 mg/cc) was used (P ⬍ 0.05). Conclusion: Caution should be exercised when using topical mitomycin-C in the treatment of airway stenosis. Local tissue effects from fibroblast inhibition may, in some instances, lead to the accumulation of fibrinous exudates that can obstruct the airway in the early postoperative period. Significance: This is the first study describing serious complications and potential risk factors related to topical mitomycin-c use in the endoscopic treatment of upper airway stenosis. Support: None reported. 11:44 AM Parental Satisfaction with Ambulatory Surgery Christopher S Song, MD (presenter); Ramez Habib, MD; Richard M Rosenfeld, MD MPH Brooklyn NY; Brooklyn NY; Brooklyn NY
9:30 AM to 10:20 AM Room JJCC 1A14 •
International Symposia: Rhinoplasty for Latin Noses Victor E Vera, MD (moderator); Jose Angel Gutierrez, MD; K J Lee, MD; M Eugene Tardy, Jr, MD; Javier J Dibildox, MD Mexico City Mexico; Mexico City Mexico; New Haven CT; Oak Park IL; San Luis Potosi Mexico To obtain good results in rhinoplasty, there are different
Research Forum/Scientific Session—Tuesday P129
Problem: Patient satisfaction is an important aspect of modern health care. Few studies have specifically addressed parental satisfaction with pediatric ambulatory surgery and no validated surveys exist. Methods: Parents of children aged 6 months to 12 years completed the AmbSurg Survey, an 18-item self-administered measure of satisfaction using a 7-point scale. Additional data collected included casemix variables and validated measures of child health-related quality of life (PedsQL 4.0 survey), positive response bias (Marlowe-Crowne Social Desirability Scale), and satisfaction with the decision to have surgery (Satisfaction with Decision Scale). Approximately 2 to 4 weeks after surgery, parents rated the degree of clinical change in their child and their satisfaction with this change. Results: We enrolled 152 parents (median age, 35) and children (median age, 4.8). Seven items were eliminated from the AmbSurg Survey because they were unclear, unimportant, or had poor test-retest reliability. The final 11-item survey had good test-retest reliability (r ⫽ .73), internal consistency (alpha ⫽ .88), and construct validity (r ⫽ .32 to .59). Factor analysis revealed subscales relating to medical care (4 items), nursing care (2 items), and communication (5 items). Survey scores were significantly associated with surgeon used, parental anxiety, child general quality of life, and parental satisfaction with the decision to have surgery. Stepwise regression, however, identified satisfaction with decision as the only significant predictor (35% of variance). AmbSurg Survey scores did not correlate with clinical change or satisfaction with change reported by parents after a median 24 days. Conclusion: Parent satisfaction with their child’s ambulatory experience can be measured efficiently with the AmbSurg survey, and correlates with satisfaction reported about the initial decision to undergo surgery. Significance: The AmbSurg Survey is a valid and reliable 11-item measure of parental satisfaction with ambulatory surgery. The ease of use and clinically relevant subscales make the survey ideal for practice audit, quality assurance endeavors, and health services research. Support: None reported.
techniques and approaches, but all of them must be performed according to the patient’s personal ethnic anatomical and esthetic characteristics in relation to the rest of the face. The surgeon has an obligation to know all these different techniques and approaches that will allow him/ her to make the exact correction in every patient and his/her own nasal and facial components. The surgeon must develop the knowledge of different tissue behavior during the surgical procedure that may have an influence in the final long-term results. The surgeon must not only have
TUESDAY
Otolaryngology– Head and Neck Surgery Volume 131 Number 2
Scientific Session—Tuesday
performed a preoperative facial analysis in every patient but must also have a surgical game plan. This seminar will discuss the routine surgical steps in rhinoplasty as well as bringing in the esthetic sense of different facial contours, particularly in the Latino population.
9:30 AM to 10:30 AM Room JJCC 1A12 •
9:38 AM CO2 Laser Microsurgery for Tis, T1, and Selected Cases of T2 Glottic Carcinoma Roberto Puxeddu, MD (presenter); Gian Peppino Ledda Cagliari Italy; Cagliari Italy
Scientific Session: Laryngology Moderators: David J. Terris, Mark K. Wax, MD
pitalization, no tracheostomy and feeding tube, and providing superior rehabilitative result with a good quality of life.
MD,
9:30 AM Our Experience in Endoscopic CO2 Laser Surgery for Supraglottic Carcinoma Stan Cotulbea, MD (presenter); Marioara Poenaru; Caius Doros, MD; Stelian Lupescu, MD; Gheorghe Iovanescu, MD; Alin Horia Marin, MD; Horatiu Stefanescu, MD Timisoara Romania; Timisoara Romania; Timisoara Romania; Timisoara Romania; Timisoara Romania; Timisoara Romania; Timisoara Timis
Objectives: This study presents the indications, general principles, contraindications, limits, and results of this modern therapeutic method. Supraglottic laryngeal carcinoma is an aggressive, with high tendency for nodal metastasis. Therefore early detection and effective treatment is of outmost importance. Open surgical procedures, primary radiotherapy, and endoscopic procedures are therapeutic alternatives, with or without neck dissection and adjuvant radiotherapy. Methods: Between 1998 –2002, 24 patients with supraglottic carcinoma T1 or T2 and N0 have been treated with supraglottic laryngectomy with CO2 laser. All patients were carefully selected using modern videoendoscopical procedures and CT scan or neck ultrasonography. Careful preoperative selection is of outmost importance for the clinical patients outcome. In the studied group, we applied horizontal supraglottic laryngectomy in 20 cases T2N0 and epiglottectomy in 4 cases T1N0. Postoperative follow-up was between 12– 48 months (average, 36 months). The thracheostomy and nasogastric tube were not necessary in any case. Results: In our group we obtained the following oncological results: no evidence of disease (NED) 19 cases (79.17%), and local recurrence in 5 cases (20.83%). All patients who presented local recurrence were stage T2N0; the salvation treatment we applied consisted in total laryngectomy. Immediate functional results were very good in all cases. Conclusions: Endoscopic CO2 laser microsurgery appears to be an effective and safe alternative treatment for T1-T2, N0 supraglottic carcinoma, with superior oncological and functional results than the other techniques, requiring short hos-
Objectives: To define the oncologic efficacy of transoral endoscopic CO2 laser surgery in early glottic carcinoma. Methods: Retrospective study of 103 patients with well to undifferentiated glottic carcinoma (14 Tis, 68 pT1a, 14 pT1b, and 7 pT2 with impairment of vocal cord mobility) were treated from October 1993 to June 2001 at the Section of Otorhinolaryngology at the Department of Surgical Sciences and Organ Transplantations of Cagliari University, Italy. Mean follow-up was 3.9 years. Surgical treatment included endoscopic CO2 laser cordectomies from type I to type Vc, according to the classification proposed by the European Laryngological Society in 2000. Results: According to the Kaplan-Meier method, the probability of remaining free of local recurrence 3 years after primary surgery was 100% for the Tis group, 93.4% for the T1 group (SE 3.85%) and 100% for the T2 group. Local control at 3 years after exclusive CO2 laser salvage surgery was 94.95% (SE 3.54%). The probability of remaining free of local recurrence 3 years after any type of salvage surgery was 100% for all the classes. Laryngeal preservation was achieved in 100% of the cases. Anterior commissure spread resulted in a not statistically significant difference in local control (P ⫽ 0.6), between the group of patients without (96.54%; SE 2.43%) and with anterior commissure involvement (87.5%; SE 11.69%). Conclusions: According to our experience, endoscopic CO2 laser surgery is an efficacious treatment for early stage glottic cancer. 9:46 AM Spectrometric Measurements in Laryngeal Cancer Christoph Arens, MD (presenter); Hiltrud Katharina Glanz, MD Giessen Germany; Giessen Germany
Objectives: Direct and indirect autofluorescence endoscopy of the larynx have proven to facilitate the detection and delineation of precancerous lesions, carcinoma in situ and cancer. The aim of the study is to evaluate spectrometric changes during autofluorescence examination in laryngeal dysplasia and cancer. Methods: In a prospective study, 42 patients with suspected precancerous or cancerous lesions were investigated during microlaryngoscopy. Autofluorescence was induced by filtered blue light (375– 440 nm) of a xenon short arc lamp and processed by a CCD camera system (D-light-AF-system).
TUESDAY
P130
Otolaryngology– Head and Neck Surgery August 2004
9:30 AM to 10:20 AM Room JJCC 1A14 •
International Symposia: Rhinoplasty for Latin Noses Victor E Vera, MD (moderator); Jose Angel Gutierrez, MD; K J Lee, MD; M Eugene Tardy, Jr, MD; Javier J Dibildox, MD Mexico City Mexico; Mexico City Mexico; New Haven CT; Oak Park IL; San Luis Potosi Mexico To obtain good results in rhinoplasty, there are different
Research Forum/Scientific Session—Tuesday P129
Problem: Patient satisfaction is an important aspect of modern health care. Few studies have specifically addressed parental satisfaction with pediatric ambulatory surgery and no validated surveys exist. Methods: Parents of children aged 6 months to 12 years completed the AmbSurg Survey, an 18-item self-administered measure of satisfaction using a 7-point scale. Additional data collected included casemix variables and validated measures of child health-related quality of life (PedsQL 4.0 survey), positive response bias (Marlowe-Crowne Social Desirability Scale), and satisfaction with the decision to have surgery (Satisfaction with Decision Scale). Approximately 2 to 4 weeks after surgery, parents rated the degree of clinical change in their child and their satisfaction with this change. Results: We enrolled 152 parents (median age, 35) and children (median age, 4.8). Seven items were eliminated from the AmbSurg Survey because they were unclear, unimportant, or had poor test-retest reliability. The final 11-item survey had good test-retest reliability (r ⫽ .73), internal consistency (alpha ⫽ .88), and construct validity (r ⫽ .32 to .59). Factor analysis revealed subscales relating to medical care (4 items), nursing care (2 items), and communication (5 items). Survey scores were significantly associated with surgeon used, parental anxiety, child general quality of life, and parental satisfaction with the decision to have surgery. Stepwise regression, however, identified satisfaction with decision as the only significant predictor (35% of variance). AmbSurg Survey scores did not correlate with clinical change or satisfaction with change reported by parents after a median 24 days. Conclusion: Parent satisfaction with their child’s ambulatory experience can be measured efficiently with the AmbSurg survey, and correlates with satisfaction reported about the initial decision to undergo surgery. Significance: The AmbSurg Survey is a valid and reliable 11-item measure of parental satisfaction with ambulatory surgery. The ease of use and clinically relevant subscales make the survey ideal for practice audit, quality assurance endeavors, and health services research. Support: None reported.
techniques and approaches, but all of them must be performed according to the patient’s personal ethnic anatomical and esthetic characteristics in relation to the rest of the face. The surgeon has an obligation to know all these different techniques and approaches that will allow him/ her to make the exact correction in every patient and his/her own nasal and facial components. The surgeon must develop the knowledge of different tissue behavior during the surgical procedure that may have an influence in the final long-term results. The surgeon must not only have
TUESDAY
Otolaryngology– Head and Neck Surgery Volume 131 Number 2
Scientific Session—Tuesday
performed a preoperative facial analysis in every patient but must also have a surgical game plan. This seminar will discuss the routine surgical steps in rhinoplasty as well as bringing in the esthetic sense of different facial contours, particularly in the Latino population.
9:30 AM to 10:30 AM Room JJCC 1A12 •
9:38 AM CO2 Laser Microsurgery for Tis, T1, and Selected Cases of T2 Glottic Carcinoma Roberto Puxeddu, MD (presenter); Gian Peppino Ledda Cagliari Italy; Cagliari Italy
Scientific Session: Laryngology Moderators: David J. Terris, Mark K. Wax, MD
pitalization, no tracheostomy and feeding tube, and providing superior rehabilitative result with a good quality of life.
MD,
9:30 AM Our Experience in Endoscopic CO2 Laser Surgery for Supraglottic Carcinoma Stan Cotulbea, MD (presenter); Marioara Poenaru; Caius Doros, MD; Stelian Lupescu, MD; Gheorghe Iovanescu, MD; Alin Horia Marin, MD; Horatiu Stefanescu, MD Timisoara Romania; Timisoara Romania; Timisoara Romania; Timisoara Romania; Timisoara Romania; Timisoara Romania; Timisoara Timis
Objectives: This study presents the indications, general principles, contraindications, limits, and results of this modern therapeutic method. Supraglottic laryngeal carcinoma is an aggressive, with high tendency for nodal metastasis. Therefore early detection and effective treatment is of outmost importance. Open surgical procedures, primary radiotherapy, and endoscopic procedures are therapeutic alternatives, with or without neck dissection and adjuvant radiotherapy. Methods: Between 1998 –2002, 24 patients with supraglottic carcinoma T1 or T2 and N0 have been treated with supraglottic laryngectomy with CO2 laser. All patients were carefully selected using modern videoendoscopical procedures and CT scan or neck ultrasonography. Careful preoperative selection is of outmost importance for the clinical patients outcome. In the studied group, we applied horizontal supraglottic laryngectomy in 20 cases T2N0 and epiglottectomy in 4 cases T1N0. Postoperative follow-up was between 12– 48 months (average, 36 months). The thracheostomy and nasogastric tube were not necessary in any case. Results: In our group we obtained the following oncological results: no evidence of disease (NED) 19 cases (79.17%), and local recurrence in 5 cases (20.83%). All patients who presented local recurrence were stage T2N0; the salvation treatment we applied consisted in total laryngectomy. Immediate functional results were very good in all cases. Conclusions: Endoscopic CO2 laser microsurgery appears to be an effective and safe alternative treatment for T1-T2, N0 supraglottic carcinoma, with superior oncological and functional results than the other techniques, requiring short hos-
Objectives: To define the oncologic efficacy of transoral endoscopic CO2 laser surgery in early glottic carcinoma. Methods: Retrospective study of 103 patients with well to undifferentiated glottic carcinoma (14 Tis, 68 pT1a, 14 pT1b, and 7 pT2 with impairment of vocal cord mobility) were treated from October 1993 to June 2001 at the Section of Otorhinolaryngology at the Department of Surgical Sciences and Organ Transplantations of Cagliari University, Italy. Mean follow-up was 3.9 years. Surgical treatment included endoscopic CO2 laser cordectomies from type I to type Vc, according to the classification proposed by the European Laryngological Society in 2000. Results: According to the Kaplan-Meier method, the probability of remaining free of local recurrence 3 years after primary surgery was 100% for the Tis group, 93.4% for the T1 group (SE 3.85%) and 100% for the T2 group. Local control at 3 years after exclusive CO2 laser salvage surgery was 94.95% (SE 3.54%). The probability of remaining free of local recurrence 3 years after any type of salvage surgery was 100% for all the classes. Laryngeal preservation was achieved in 100% of the cases. Anterior commissure spread resulted in a not statistically significant difference in local control (P ⫽ 0.6), between the group of patients without (96.54%; SE 2.43%) and with anterior commissure involvement (87.5%; SE 11.69%). Conclusions: According to our experience, endoscopic CO2 laser surgery is an efficacious treatment for early stage glottic cancer. 9:46 AM Spectrometric Measurements in Laryngeal Cancer Christoph Arens, MD (presenter); Hiltrud Katharina Glanz, MD Giessen Germany; Giessen Germany
Objectives: Direct and indirect autofluorescence endoscopy of the larynx have proven to facilitate the detection and delineation of precancerous lesions, carcinoma in situ and cancer. The aim of the study is to evaluate spectrometric changes during autofluorescence examination in laryngeal dysplasia and cancer. Methods: In a prospective study, 42 patients with suspected precancerous or cancerous lesions were investigated during microlaryngoscopy. Autofluorescence was induced by filtered blue light (375– 440 nm) of a xenon short arc lamp and processed by a CCD camera system (D-light-AF-system).
TUESDAY
P130
Otolaryngology– Head and Neck Surgery August 2004