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Prognostic value of sinus mucosa histology
P52
Otolaryngology Head and Neck Surgery August 1997
Scientific Sessions--Sunday
open. Five patients were deemed to have good levator function, at least 10 mm distance. Eighteen were deemed to have moderate function, 6 to 10 mm distance. Two patients were deemed to have poor function, less than 6 mm distance. Degree of ptosis in terms of lagopthalmos was measured preoperatively as well; 0 to 2 mm of lag represented minimal ptosis; 2 to 4 mm, moderate ptosis; 4 to 6 mm, severe ptosis; and greater than 6 mm, profound ptosis. Levator plication was utilized for corrections of 0 to 4 mm of ptosis. Levator resection was utilized at all other times. Results: Ptosis was improved in all patients. All five patients with good levator function and six patients with moderate levator function underwent levator plication. Permanent correction of 2 to 5 mm was seen. The remaining 14 patients underwent levator resection with permanent corrections of 4 to 11 ram. Six of the 14 patients required repairs of the contralateral lid. Conclusion: Ptosis is a commonly seen and often misunderstood problem. Corrective surgery should be individualized to the patient's needs and based on solid measurements of levator function and ptosis. Often when dealing with more severe cases, the contralateral lid may also need to be addressed surgically. Proper patient selection and counseling are paramount to ensuring excellent results. 10:46 AM
The Effects of Vasoactive Topical Agents on the Survival of Dorsal Skin Flaps in Rats DANIEL K. SMITH, MD (presenter), and ROBERTDOLAN, MD, Boston, Mass.
Method: A single 9 x 2 cm caudally based dorsal random skin flap was raised in 35 adult Sprague-Dawley rats. The animals were then assigned to either a control group of five rats or one of three treatment groups of 10 rats each. All animals had either a white petroleum ointment (control group), Prostaglandin E2, Minoxidil, or nitroglycerin applied topically to the flap over a 72-hour period. On postoperative day 7 the animals were sacrificed and the viability of all flaps was determined with a grid system. Results: No untoward events such as hematomas or infections were encountered. The control group had an average survival area of 60.8% +- 7.9%. The nitroglycerin group and Minoxidil group were not significantly different, with an average area of survival of 60.1% _+8.1% and 63.3% _+4.7%, respectively. The Prostaglandin E2 group had an average of survival of 74.2% _+ 10.5% (p = 0.002). Discussion: Three readily available agents with proven clinical safety were used to assess their effect on flap survival. Only Prostaglandin E2 demonstrated a significant increase in flap survival. N i t r o g l y c e r i n o i n t m e n t and Minoxidil had no beneficial effects when compared with control. Topical Prostaglandin E2 is effective in improving the survival of the distal segment of random skin flaps in rats.
11:00 AM
The Bone That Best Matches the Dimensions and Biomechanical Properties of the Mandible HADI SEIKALY,MD, FRSC (presenter), FAN LI, MD, BRIAN DRISCOLL, MD, LUKE K.S, TAN, MD, DOREE SEIKALY, RN, RDH, JASON CALHOUN, MD, KAREN CALHOUN, MD, and CHRISTOPHER RASSEKH, MD, Edmonton, Alberta, Canada, and Galveston, Tex.
Objective: Oromandibular reconstruction after major ablative surgery or trauma is one of the most challenging and complex problems encountered by the head and neck reconstructive surgeon. Free vascularized bone-containing flaps with dental implants revolutionized mandibular reconstruction and are currently considered to be the most successful and reliable method of reconstruction. This study was designed to tabulate the dimensions of the bones used in mandibular reconstruction and to compare their biomechanical properties to that of the mandible. Methods: Eleven formalin-fixed cadavers were used (five females and six males). The mandible, fibulae, iliac crests, scapulae, clavicles, second metatarsals, radii, and anterior ribs were harvested. Measurements of the dimensions of the bones were made with calipers at multiple sites. Three point breaking and screw pulling strength tests were then performed on all the bones. Results: The average age of the cadavers was 72.8. The fibulae, iliac crests, and clavicles had dimensions that best compared with that of the mandible and were consistently found to be adequate for dental implantation. The scapulae had appropriate dimensions for implantation only in males. The three point break torque and screw pulling strength were consistently the highest for the mandibles and fibulae, followed by clavicles, scapulae, iliac crests, metatarsals, radii, and ribs, in that order. Conclusions: All the tested bones have been successfully transferred and used to reconstruct the mandible. The bones that best match the mandibular properties and are consistently implantable are the fibulae, clavicles, and iliac crests. The clinical significance of these findings will be discussed. 11:08 AM Prognostic Value of Sinus Mucosa Histology STEVEN C. MARKS, MD (presenter), Detroit, Mich.
Objective: To investigate the prognostic implications of sinus mucosa histology in a series of patients undergoing endoscopic sinus surgery. Method: Pathology specimens were retrospectively reviewed for 53 consecutive patients in whom specimens were available. In each patient the slides were evaluated by cell counting for density of cellular infiltration of lymphocytes, eosinophils, and neutrophils. Preoperative history, CT scan, and long-term outcome were also assessed. Outcome was assessed by a symptom questionnaire, endoscopic examination, and the need for further surgery.
Otolaryngology Head and Neck Surgery August 1997
Scientific Sessions--Sunday
open. Five patients were deemed to have good levator function, at least 10 mm distance. Eighteen were deemed to have moderate function, 6 to 10 mm distance. Two patients were deemed to have poor function, less than 6 mm distance. Degree of ptosis in terms of lagopthalmos was measured preoperatively as well; 0 to 2 mm of lag represented minimal ptosis; 2 to 4 mm, moderate ptosis; 4 to 6 mm, severe ptosis; and greater than 6 mm, profound ptosis. Levator plication was utilized for corrections of 0 to 4 mm of ptosis. Levator resection was utilized at all other times. Results: Ptosis was improved in all patients. All five patients with good levator function and six patients with moderate levator function underwent levator plication. Permanent correction of 2 to 5 mm was seen. The remaining 14 patients underwent levator resection with permanent corrections of 4 to 11 ram. Six of the 14 patients required repairs of the contralateral lid. Conclusion: Ptosis is a commonly seen and often misunderstood problem. Corrective surgery should be individualized to the patient's needs and based on solid measurements of levator function and ptosis. Often when dealing with more severe cases, the contralateral lid may also need to be addressed surgically. Proper patient selection and counseling are paramount to ensuring excellent results. 10:46 AM
The Effects of Vasoactive Topical Agents on the Survival of Dorsal Skin Flaps in Rats DANIEL K. SMITH, MD (presenter), and ROBERTDOLAN, MD, Boston, Mass.
Method: A single 9 x 2 cm caudally based dorsal random skin flap was raised in 35 adult Sprague-Dawley rats. The animals were then assigned to either a control group of five rats or one of three treatment groups of 10 rats each. All animals had either a white petroleum ointment (control group), Prostaglandin E2, Minoxidil, or nitroglycerin applied topically to the flap over a 72-hour period. On postoperative day 7 the animals were sacrificed and the viability of all flaps was determined with a grid system. Results: No untoward events such as hematomas or infections were encountered. The control group had an average survival area of 60.8% +- 7.9%. The nitroglycerin group and Minoxidil group were not significantly different, with an average area of survival of 60.1% _+8.1% and 63.3% _+4.7%, respectively. The Prostaglandin E2 group had an average of survival of 74.2% _+ 10.5% (p = 0.002). Discussion: Three readily available agents with proven clinical safety were used to assess their effect on flap survival. Only Prostaglandin E2 demonstrated a significant increase in flap survival. N i t r o g l y c e r i n o i n t m e n t and Minoxidil had no beneficial effects when compared with control. Topical Prostaglandin E2 is effective in improving the survival of the distal segment of random skin flaps in rats.
11:00 AM
The Bone That Best Matches the Dimensions and Biomechanical Properties of the Mandible HADI SEIKALY,MD, FRSC (presenter), FAN LI, MD, BRIAN DRISCOLL, MD, LUKE K.S, TAN, MD, DOREE SEIKALY, RN, RDH, JASON CALHOUN, MD, KAREN CALHOUN, MD, and CHRISTOPHER RASSEKH, MD, Edmonton, Alberta, Canada, and Galveston, Tex.
Objective: Oromandibular reconstruction after major ablative surgery or trauma is one of the most challenging and complex problems encountered by the head and neck reconstructive surgeon. Free vascularized bone-containing flaps with dental implants revolutionized mandibular reconstruction and are currently considered to be the most successful and reliable method of reconstruction. This study was designed to tabulate the dimensions of the bones used in mandibular reconstruction and to compare their biomechanical properties to that of the mandible. Methods: Eleven formalin-fixed cadavers were used (five females and six males). The mandible, fibulae, iliac crests, scapulae, clavicles, second metatarsals, radii, and anterior ribs were harvested. Measurements of the dimensions of the bones were made with calipers at multiple sites. Three point breaking and screw pulling strength tests were then performed on all the bones. Results: The average age of the cadavers was 72.8. The fibulae, iliac crests, and clavicles had dimensions that best compared with that of the mandible and were consistently found to be adequate for dental implantation. The scapulae had appropriate dimensions for implantation only in males. The three point break torque and screw pulling strength were consistently the highest for the mandibles and fibulae, followed by clavicles, scapulae, iliac crests, metatarsals, radii, and ribs, in that order. Conclusions: All the tested bones have been successfully transferred and used to reconstruct the mandible. The bones that best match the mandibular properties and are consistently implantable are the fibulae, clavicles, and iliac crests. The clinical significance of these findings will be discussed. 11:08 AM Prognostic Value of Sinus Mucosa Histology STEVEN C. MARKS, MD (presenter), Detroit, Mich.
Objective: To investigate the prognostic implications of sinus mucosa histology in a series of patients undergoing endoscopic sinus surgery. Method: Pathology specimens were retrospectively reviewed for 53 consecutive patients in whom specimens were available. In each patient the slides were evaluated by cell counting for density of cellular infiltration of lymphocytes, eosinophils, and neutrophils. Preoperative history, CT scan, and long-term outcome were also assessed. Outcome was assessed by a symptom questionnaire, endoscopic examination, and the need for further surgery.