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Management of the difficult mandible
Otolaryngology Head and Neck Surgery
Volume 112 Number5
COURSE 4723-1
One-period course ($20)
Instruction Courses--Wednesday
Room NOCC-85 3:45-4:45
N e c k Masses in Children HASSAN H. RAMADAN, MD, and MARK K. WAX, MD
Morgantown, W.Va.
Educational objectives: To develop a practical approach to the evaluation of a child with a neck mass and to become familiar with etiologies, clinical diagnosis, and management of midline, lateral, and posterior neck masses.
Neck masses in children are fairly common. The otolaryngologist is often consulted for these neck masses that do not respond to medical treatment. Neck masses can be inflammatory, congenital, or malignant. From 5% to 11% of the masses biopsied in children are malignant, 27% to 38% are inflammatory, and approximately 45% to 55% are congenital. The otolaryngologist should use a systematic approach when consulted to evaluate a neck mass, to determine whether a biopsy is needed. Details of the evaluation will be discussed during this instructional course with emphasis on history, physical exam, and lab tests and xrays. Since most of the inflammatory lesions are treated by primary care providers, we will emphasize the diagnosis and management of congenital benign lesions and malignant lesions. However, some of the inflammatory lesions that do not respond readily to medical treatment will present a challenge to the otolaryngologist and, an organized approach to these cases will be presented. The role of fine needle aspiration in the evaluation of these children along with our experience will be presented. The issue of how long one can walt before biopsying or excising a neck mass will be addressed. Photos and illustrations of different kinds of neck masses, including branchial cysts, thyroglossal duct cysts, and cystic hygroma, will be presented.
COURSE 4724-1 One-period course ($20)
Room NOCC-86 3:45-4:45
M a n a g e m e n t of the Difficult Mandible STEPHENJ. WETMORE, MD, and J. MICHAEL KEY, MD
Morgantown, W. Va., and Little Rock, Ark.
Educational objectives: To understand the difficulties involved in the management of complex mandibular trauma and to familiarize the participant with the decision making options with common difficult mandible fractures.
The maxillofacial surgeon must learn when the standard treatment modalities are inadequate to provide excellent results in terms of both occlusion and bone healing when dealing with difficult mandible fractures. The surgeon must either master a combination of techniques that will provide
P 189
the desired results, or recognize which types of fractures should be referred to the surgeon who has mastered these techniques. This course proposes to teach the principals of treatment of eight commonly occurring difficult mandible fractures and their proposed methods of treatment. The course will cover multiply comminuted fractures, bilateral condylar fractures, fractures with teeth in the line of fracture, condylar fractures associated with midface fractures, displaced fractures in children, body fractures in atrophic mandibles, and traumatic loss of portions of the mandible. Specifics regarding the application of arch bars and ivy loops will be mentioned, as well as the construction of acrylic splints. We will teach the application of the external biphase fixation, the biphase plus head frame. Extensive discussion of bone plate application compared to traditional methods of treatment and the use of the bone grafts in repairs of the mandible will be emphasized. It is the intention of this course to give the student the basic understanding of the difficulties involved in the management of complex mandibular trauma and the basic options and their applications.
COURSE 4725-1
One-period course ($20)
Room NOCC-87 3:45-4:45
Practical Pediatric Audiology THOMAS A. LII"rMAN, PhD, and NEWTON O. DUNCAN, MD
Houston, Texas
Educational objectives: To develop an awareness of the effectiveness of behavioral audiologic testing in children under 3 years of age and to develop an understanding of advances in ABR and otoacoustic emissions and their role in testing of young children.
Children under 3 years, and often as young as 6 months, are capable of providing reliable behavioral audiometric information. The primary purpose of this presentation is to provide a practical update on the role and use of behavioral audiologic test procedures in young children. At Texas Children's Hospital, where more than 4000 children are tested annually, such behavioral tests have reduced the need for ABR testing with sedation by 35%. Videotaped demonstrations of various diagnostic procedures will be provided, along with guidelines for test interpretation. A second purpose of this presentation is to review current applications of otoacoustic emissions and ABR in clinical pediatric audiology. The use of transient-evoked and distortion product emissions will be discussed, along with frequencyspecific and bone conduction ABR. Finally, the presentation will address neonatal hearing screening in the neonatal ICU. The benefits and limitations of otoacoustic emissions and ABR will be discussed. Risk factors, testing options, and prevalence statistics will also be reviewed.
Volume 112 Number5
COURSE 4723-1
One-period course ($20)
Instruction Courses--Wednesday
Room NOCC-85 3:45-4:45
N e c k Masses in Children HASSAN H. RAMADAN, MD, and MARK K. WAX, MD
Morgantown, W.Va.
Educational objectives: To develop a practical approach to the evaluation of a child with a neck mass and to become familiar with etiologies, clinical diagnosis, and management of midline, lateral, and posterior neck masses.
Neck masses in children are fairly common. The otolaryngologist is often consulted for these neck masses that do not respond to medical treatment. Neck masses can be inflammatory, congenital, or malignant. From 5% to 11% of the masses biopsied in children are malignant, 27% to 38% are inflammatory, and approximately 45% to 55% are congenital. The otolaryngologist should use a systematic approach when consulted to evaluate a neck mass, to determine whether a biopsy is needed. Details of the evaluation will be discussed during this instructional course with emphasis on history, physical exam, and lab tests and xrays. Since most of the inflammatory lesions are treated by primary care providers, we will emphasize the diagnosis and management of congenital benign lesions and malignant lesions. However, some of the inflammatory lesions that do not respond readily to medical treatment will present a challenge to the otolaryngologist and, an organized approach to these cases will be presented. The role of fine needle aspiration in the evaluation of these children along with our experience will be presented. The issue of how long one can walt before biopsying or excising a neck mass will be addressed. Photos and illustrations of different kinds of neck masses, including branchial cysts, thyroglossal duct cysts, and cystic hygroma, will be presented.
COURSE 4724-1 One-period course ($20)
Room NOCC-86 3:45-4:45
M a n a g e m e n t of the Difficult Mandible STEPHENJ. WETMORE, MD, and J. MICHAEL KEY, MD
Morgantown, W. Va., and Little Rock, Ark.
Educational objectives: To understand the difficulties involved in the management of complex mandibular trauma and to familiarize the participant with the decision making options with common difficult mandible fractures.
The maxillofacial surgeon must learn when the standard treatment modalities are inadequate to provide excellent results in terms of both occlusion and bone healing when dealing with difficult mandible fractures. The surgeon must either master a combination of techniques that will provide
P 189
the desired results, or recognize which types of fractures should be referred to the surgeon who has mastered these techniques. This course proposes to teach the principals of treatment of eight commonly occurring difficult mandible fractures and their proposed methods of treatment. The course will cover multiply comminuted fractures, bilateral condylar fractures, fractures with teeth in the line of fracture, condylar fractures associated with midface fractures, displaced fractures in children, body fractures in atrophic mandibles, and traumatic loss of portions of the mandible. Specifics regarding the application of arch bars and ivy loops will be mentioned, as well as the construction of acrylic splints. We will teach the application of the external biphase fixation, the biphase plus head frame. Extensive discussion of bone plate application compared to traditional methods of treatment and the use of the bone grafts in repairs of the mandible will be emphasized. It is the intention of this course to give the student the basic understanding of the difficulties involved in the management of complex mandibular trauma and the basic options and their applications.
COURSE 4725-1
One-period course ($20)
Room NOCC-87 3:45-4:45
Practical Pediatric Audiology THOMAS A. LII"rMAN, PhD, and NEWTON O. DUNCAN, MD
Houston, Texas
Educational objectives: To develop an awareness of the effectiveness of behavioral audiologic testing in children under 3 years of age and to develop an understanding of advances in ABR and otoacoustic emissions and their role in testing of young children.
Children under 3 years, and often as young as 6 months, are capable of providing reliable behavioral audiometric information. The primary purpose of this presentation is to provide a practical update on the role and use of behavioral audiologic test procedures in young children. At Texas Children's Hospital, where more than 4000 children are tested annually, such behavioral tests have reduced the need for ABR testing with sedation by 35%. Videotaped demonstrations of various diagnostic procedures will be provided, along with guidelines for test interpretation. A second purpose of this presentation is to review current applications of otoacoustic emissions and ABR in clinical pediatric audiology. The use of transient-evoked and distortion product emissions will be discussed, along with frequencyspecific and bone conduction ABR. Finally, the presentation will address neonatal hearing screening in the neonatal ICU. The benefits and limitations of otoacoustic emissions and ABR will be discussed. Risk factors, testing options, and prevalence statistics will also be reviewed.