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Morbidity and mortality in children associated with the use of tobacco products by other people
Abstracts FESS With and Imaging Lopatin 10:51-54.1996.
Without the Availability AS, Piskunov GZ. Am
of CT J Rhino1
It is taught that endoscopic sinus surgery should not be performed in the absence of preoperative computed tomography (CT) scans available in the operating room. In fact, in most teaching hospitals it would be unconsciousable to initiate endoscopic sinus surgery without the presence of the films displayed on the view boxes in the operating room. The authors reviewed 322 FESS procedures they had performed in ZOO patients in the former Soviet Union. Roughly half of the surgical procedures were performed before the availability of CT scans and the other half performed after standard preoperative CT scanning following equipment acquisition. Surprisingly, they were unable to show a significant difference in the incidence of complications between the two groups. The authors of this report note that knowledge of endoscopic anatomy and surgical technique was of far greater significance in the avoidance of complication than the findings noted on preoperative radiographic imaging. Although it is unlikely that a change in current practice patterns is either likely or desirable, the article emphasizes the primacy of the surgeons’ experience with endoscopic anatomy and surgical technique in the prevention of complications. David E. Eibling,
MD, FACS
Relationship of the Optic Nerve to the Posterior Paranasal Sinuses: A CT Anatomic Study. DeLano MC, Fun FY, Zinreich SJ, AJNR Am J Neuroradiol 17:669-675, 1996. Direct coronal sinus CT scans of 1.50 consecutive patients (300 nerves) were reviewed to delineate the relationship between the optic nerves and the posterior paranasal sinuses. They were classified into four types. Type I nerves course adjacent to the sphenoid sinus without indentation of the wall (76%). Type II nerves course adjacent to the sphenoid sinus, causing indentation of the sinus wall (15%). Type III nerves course through the sphenoid sinus (6%). Type IV nerves course immediately adjacent to the sphenoid sinus and the posterior ethmoid air cell (3%). Dehiscence of bone over the optic nerve was found in 24% of the nerves. The authors conclude that “anatomic configurations that predispose the optic nerve to injury include Type II or III optic nerves, bone dehiscence over the nerve, and pneumatization of the anterior clinoid of axial process.” They also advocate the addition imaging to coronal imaging because of its improved display of the sphenoethmoidal boundary by axial 290
American
Journal
of Otolaryngology,
images. Their study highlights the importance of detecting normal anatomic variations of the paranasal sinuses on preoperative scans to prevent inadvertent injury to the optic nerve during endoscopic sinus surgery. Irregardless of the type of nerve course, the surgeon would be well-advised to avoid instrumentation of the lateral walls of the posterior ethmoid and sphenoid sinuses. Carl H. Snyderman,
MD
Clinical Experience With a Microvascular Anastomotic Device in Head and Neck Reconstruction. DeLacure MD, Wong RS, Markowitz BL, et al. Am J Surg 170:521-523,1995 The microvascular anastamoses is one of the most technically sensitive aspects of free tissue transfer. Anastomotic coupling systems to mechanically approximate vessel ends were first introduced in 1962. In this country, the #M MACD is the primary coupling system used. There have been scattered reports on the efficacy of this device in the head and neck literature. The authors of this study report on the use of the 3M MACD in 29 head and neck free-tissue transfers. Free-tissue transfer was used for the following reason: cancer (zz), soft tissue augmentation (5), facial nerve reconstruction (l), and cervical esophageal reconstruction (1). Five patients received radiotherapy preoperatively. Free flaps consisted of: radial forearm (g), fibula (7), scapula (6), rectus (3), and other (4). A total of 37 anastomoses were completed using the device: 30 venous and 7 arterial. An assortment of recipient vessels were used and all anastomoses were performed in an end-to-end manner. Twenty-four anastomoses used a 2.5-mm device, 12 used a 2.0-mm device, and one used a 1.5-mm device. The average time to complete the anastomoses was 5 minutes. Thirty-five of 37 were considered successful. The principles of a tension free anastomoses with a good size match are emphasized in this article. What is most important is that the technical expertise to perform a suture microvascular anastomoses was still needed to complete the majority of the arterial procedures. The use of this device cannot substitute for mastery of conventional suture technique. David
E. Eibling,
MD, FACS
Morbidity and Mortality in Children Associated With the Use of Tobacco Products by Other People. DiFranza J, Lew R. Pediatrics 97:560-568, 1996. DiFranza and Lew from the University chusetts Medical Center, Fitchburg,
Vol 18, No 4 (July-August),
1997:
pp 290-291
of MassaMA, and
291 ABSTRACTS
Brigham and Women’s Hospital, Boston, MA, have performed an important meta-analysis looking at the association between health problems in children and environmental tobacco smoke (ETS). ETS was found to be associated with the numbers of illnesses, operations, and deaths in American children per year listed below (95% confidence intervals): 1) otitis media, 2% to 13% of cases; 2) tympanostomy tubes, 1% to 26% of operations; 3) tonsillectomy and adenoidectomy, 16% to 24% of operations; 4) asthma, 8% to 13% of cases; 5) cough, 10% to 16% of cases; 6) lower respiratory tract infection in children <5 years old, 12% to 20% of cases; 7) death from lower respiratory tract infection in children <5 years old, 136 to 212 children; 8) deaths from fires initiated by smoking materials, 148 children. It is important for otolaryngologists to educate parents about the adverse effects of smoking on their children, Robert Yellon, MD Exploring the Use of the Medicinal Leech: A Clinical Risk-Benefit Analysis. de Chalain TMB. J Recon-
str Microsurg
12:165-172,1996,
The medicinal leech, Hirudo medicinalis, has been used with increasing frequency for salvage of compromised pedicled flaps and microvascular free-tissue transfers. After reaching a popular peak in Europe in the early nineteenth century, the practice gradually fell from favor until, by the middle of the twentieth century, it almost disappeared. Recently, leech therapy has become more popular in the management of flaps with venous compromise. The authors of this article performed a retrospective review of 18 patients at their institutions in which leech therapy was used and reviewed, 36 reports over a ?&year period that encompassed 108 patients. They reviewed the indications for leech therapy, the length of time leeches were applied, antibiotic usage, blood transfusion, infections, as well as flap survival.
Three of their 18 compromised flaps were pedicled, of which one was for head and neck reconstruction (it survived with leech treatment). Of the 12 primary microvascular flaps, four were for breast reconstruction, four were done for trauma! and four were for reconstruction of the head and neck after oncologic resection. All five of the flaps managed with leech therapy following head and neck reconstruction survived. All microvascular free flaps were re-explored and the venous anastomoses revised. Three cases of replanted tissue were managed with leech therapy. Three cases of free tissue replantation (without microvascular anastomosis) were managed with leech therapy. Aeromonas h-ydrophila infection occurred in two patients (11%). Sixty-six percent of patients required a transfusion with a mean of 4.4 units given, Duration of leech treatment averaged 3 days. Review of the literature showed that the major indication for leech therapy was free-tissue replantation (not microvascular anastomosis). Fifty percent pedicled flaps were the next most common, whereas free flaps accounted for less than 10%. Leech therapy is most valuable in tissue replantation in flaps when there is compromise of venous outflow. The authors stress that leeches cannot substitute for good technique and re-exploration. All salvaged free flaps in this series required reexploration in addition to leech therapy. Salvage rates with the use of leeches was approximately 76%. Infection with Aeromonas hydrophila occurs in up to 20% of cases, and is usually associated with flap 10~s.Treatment of aeromonas infection is with an antibiotic to which it is sensitive. Good technique and attention to detail concerning pedicle length, kinking, and so forth are the most important factor to insure free flap survival. Leeches occasionally may be used by the head and neck surgeon to assist in the salvage of flaps or replanted tissue. Prophylactic use of antibiotics should be considered. Mark K. Wax, MD
Without the Availability AS, Piskunov GZ. Am
of CT J Rhino1
It is taught that endoscopic sinus surgery should not be performed in the absence of preoperative computed tomography (CT) scans available in the operating room. In fact, in most teaching hospitals it would be unconsciousable to initiate endoscopic sinus surgery without the presence of the films displayed on the view boxes in the operating room. The authors reviewed 322 FESS procedures they had performed in ZOO patients in the former Soviet Union. Roughly half of the surgical procedures were performed before the availability of CT scans and the other half performed after standard preoperative CT scanning following equipment acquisition. Surprisingly, they were unable to show a significant difference in the incidence of complications between the two groups. The authors of this report note that knowledge of endoscopic anatomy and surgical technique was of far greater significance in the avoidance of complication than the findings noted on preoperative radiographic imaging. Although it is unlikely that a change in current practice patterns is either likely or desirable, the article emphasizes the primacy of the surgeons’ experience with endoscopic anatomy and surgical technique in the prevention of complications. David E. Eibling,
MD, FACS
Relationship of the Optic Nerve to the Posterior Paranasal Sinuses: A CT Anatomic Study. DeLano MC, Fun FY, Zinreich SJ, AJNR Am J Neuroradiol 17:669-675, 1996. Direct coronal sinus CT scans of 1.50 consecutive patients (300 nerves) were reviewed to delineate the relationship between the optic nerves and the posterior paranasal sinuses. They were classified into four types. Type I nerves course adjacent to the sphenoid sinus without indentation of the wall (76%). Type II nerves course adjacent to the sphenoid sinus, causing indentation of the sinus wall (15%). Type III nerves course through the sphenoid sinus (6%). Type IV nerves course immediately adjacent to the sphenoid sinus and the posterior ethmoid air cell (3%). Dehiscence of bone over the optic nerve was found in 24% of the nerves. The authors conclude that “anatomic configurations that predispose the optic nerve to injury include Type II or III optic nerves, bone dehiscence over the nerve, and pneumatization of the anterior clinoid of axial process.” They also advocate the addition imaging to coronal imaging because of its improved display of the sphenoethmoidal boundary by axial 290
American
Journal
of Otolaryngology,
images. Their study highlights the importance of detecting normal anatomic variations of the paranasal sinuses on preoperative scans to prevent inadvertent injury to the optic nerve during endoscopic sinus surgery. Irregardless of the type of nerve course, the surgeon would be well-advised to avoid instrumentation of the lateral walls of the posterior ethmoid and sphenoid sinuses. Carl H. Snyderman,
MD
Clinical Experience With a Microvascular Anastomotic Device in Head and Neck Reconstruction. DeLacure MD, Wong RS, Markowitz BL, et al. Am J Surg 170:521-523,1995 The microvascular anastamoses is one of the most technically sensitive aspects of free tissue transfer. Anastomotic coupling systems to mechanically approximate vessel ends were first introduced in 1962. In this country, the #M MACD is the primary coupling system used. There have been scattered reports on the efficacy of this device in the head and neck literature. The authors of this study report on the use of the 3M MACD in 29 head and neck free-tissue transfers. Free-tissue transfer was used for the following reason: cancer (zz), soft tissue augmentation (5), facial nerve reconstruction (l), and cervical esophageal reconstruction (1). Five patients received radiotherapy preoperatively. Free flaps consisted of: radial forearm (g), fibula (7), scapula (6), rectus (3), and other (4). A total of 37 anastomoses were completed using the device: 30 venous and 7 arterial. An assortment of recipient vessels were used and all anastomoses were performed in an end-to-end manner. Twenty-four anastomoses used a 2.5-mm device, 12 used a 2.0-mm device, and one used a 1.5-mm device. The average time to complete the anastomoses was 5 minutes. Thirty-five of 37 were considered successful. The principles of a tension free anastomoses with a good size match are emphasized in this article. What is most important is that the technical expertise to perform a suture microvascular anastomoses was still needed to complete the majority of the arterial procedures. The use of this device cannot substitute for mastery of conventional suture technique. David
E. Eibling,
MD, FACS
Morbidity and Mortality in Children Associated With the Use of Tobacco Products by Other People. DiFranza J, Lew R. Pediatrics 97:560-568, 1996. DiFranza and Lew from the University chusetts Medical Center, Fitchburg,
Vol 18, No 4 (July-August),
1997:
pp 290-291
of MassaMA, and
291 ABSTRACTS
Brigham and Women’s Hospital, Boston, MA, have performed an important meta-analysis looking at the association between health problems in children and environmental tobacco smoke (ETS). ETS was found to be associated with the numbers of illnesses, operations, and deaths in American children per year listed below (95% confidence intervals): 1) otitis media, 2% to 13% of cases; 2) tympanostomy tubes, 1% to 26% of operations; 3) tonsillectomy and adenoidectomy, 16% to 24% of operations; 4) asthma, 8% to 13% of cases; 5) cough, 10% to 16% of cases; 6) lower respiratory tract infection in children <5 years old, 12% to 20% of cases; 7) death from lower respiratory tract infection in children <5 years old, 136 to 212 children; 8) deaths from fires initiated by smoking materials, 148 children. It is important for otolaryngologists to educate parents about the adverse effects of smoking on their children, Robert Yellon, MD Exploring the Use of the Medicinal Leech: A Clinical Risk-Benefit Analysis. de Chalain TMB. J Recon-
str Microsurg
12:165-172,1996,
The medicinal leech, Hirudo medicinalis, has been used with increasing frequency for salvage of compromised pedicled flaps and microvascular free-tissue transfers. After reaching a popular peak in Europe in the early nineteenth century, the practice gradually fell from favor until, by the middle of the twentieth century, it almost disappeared. Recently, leech therapy has become more popular in the management of flaps with venous compromise. The authors of this article performed a retrospective review of 18 patients at their institutions in which leech therapy was used and reviewed, 36 reports over a ?&year period that encompassed 108 patients. They reviewed the indications for leech therapy, the length of time leeches were applied, antibiotic usage, blood transfusion, infections, as well as flap survival.
Three of their 18 compromised flaps were pedicled, of which one was for head and neck reconstruction (it survived with leech treatment). Of the 12 primary microvascular flaps, four were for breast reconstruction, four were done for trauma! and four were for reconstruction of the head and neck after oncologic resection. All five of the flaps managed with leech therapy following head and neck reconstruction survived. All microvascular free flaps were re-explored and the venous anastomoses revised. Three cases of replanted tissue were managed with leech therapy. Three cases of free tissue replantation (without microvascular anastomosis) were managed with leech therapy. Aeromonas h-ydrophila infection occurred in two patients (11%). Sixty-six percent of patients required a transfusion with a mean of 4.4 units given, Duration of leech treatment averaged 3 days. Review of the literature showed that the major indication for leech therapy was free-tissue replantation (not microvascular anastomosis). Fifty percent pedicled flaps were the next most common, whereas free flaps accounted for less than 10%. Leech therapy is most valuable in tissue replantation in flaps when there is compromise of venous outflow. The authors stress that leeches cannot substitute for good technique and re-exploration. All salvaged free flaps in this series required reexploration in addition to leech therapy. Salvage rates with the use of leeches was approximately 76%. Infection with Aeromonas hydrophila occurs in up to 20% of cases, and is usually associated with flap 10~s.Treatment of aeromonas infection is with an antibiotic to which it is sensitive. Good technique and attention to detail concerning pedicle length, kinking, and so forth are the most important factor to insure free flap survival. Leeches occasionally may be used by the head and neck surgeon to assist in the salvage of flaps or replanted tissue. Prophylactic use of antibiotics should be considered. Mark K. Wax, MD