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Stapedectomy with vein graff and teflon piston
Otolaryngo|ogy Head and Neck Surgery
Volume 112 Number 5
Instruction Courses--Sunday P67
initial consultation, billing, informed consent, treatment, complications, and poor results. The course is completely updated yearly to keep the material current.
COURSE 1841 - 1
One-period course ($20)
Room NOCC-104 4:15-5:15
Stapedectomy with Vein Graft and Teflon Piston JOHN J. SHEA,JR., MD
Memphis, Tenn. COURSE 1840-1
One-period course ($20)
Room NOCC- 103 4:15-5:15
Performance a n d M a n a g e m e n t of Long-Term Tracheostomy ISAAC ELIACHAR, MD, and FRANKMILLER, MD
Cleveland, Ohio, and Andrews AFB, Md.
Educational objectives: To determine the indications of performing long-term tracheostomy, better understand the advantage, pitfalls, complications, etc., and to plan and perform this surgical procedure and become knowledgeable in the postoperative management. Long-term flap tracheostomy (LTT) has been advocated to manage longstanding upper airway obstruction. This surgical procedure creates a short, self-staining, completely healed, skin-lined tract between the tracheal mucosa and the anterior skin of the neck. Indications include bilateral vocal cord paralysis or fixation, laryngeal or tracheal stenosis, severe obstructive sleep apnea, intractable aspiration, chronic lung disease and more. This course will demonstrate how the establishment of LTT may be the beginning of a rational, fully thought out and properly executed management of chronic upper airway disease and obstruction. Contrary to frequently encountered experience, LTT is the beginning of a prolonged recovery and maintenance rather than an end procedure performed in severely diseased and hopeless cases. This course will review the surgical technique and the extensive experience for the performance and management of LTT developed at the Cleveland Clinic Foundation. It will include the use of specially designed tracheostomal stents to prevent or minimize the long-term complications associated with the standard curved tracheostomy tube. Once optimal postoperative healing is achieved, the patients enjoy a post laryngectomylike tracheastoma, which may be either maintained with no tube at all or through the application of a readily introduced, self-retaining tracheostomy stent, providing a oneway valve for voice production. Normal or optimal voice has been shown to be preserved throughout a very extensive follow-up. The course will demonstrate the pitfalls, potential side effects and complications. LTT carries significant advantages over standard tracheostomy. It is well tolerated and effective in the treatment of multiple chronic airway diseases.
Educational objectives: To know how to recognize otosclerosis, which patients to operate on, and how toperform a stapedectomy. Otosclerosis is a progressive disorder of the temporal bone that causes ankylosis o f the stapes footplate and conductive hearing loss. It begins in early adult life, is familial, with a recessive tendency, and is believed to be aggravated by pregnancy. It usually begins in the fissura ante fenestra, just in front of the oval window, as a remodeling of bone that enlarges and eventually invades and fixes the stapes footplate. The diagnosis is made by the typical history of a progressive, low-tone conductive hearing loss, often with a family history of similar hearing loss, and a type A tympanogram, with an absent stapedial reflex. Surgical treatment is aimed at making a small opening in the center of the footplate and reconstructing the sound-conducting mechanism of the middle ear. The surgical technique and postoperative care are described in detail. In ears with localized or widespread otosclerosis, narrowing the oval window and even obliterating the edges, a small fenestra is made in the thin central part of the footplate with an argon laser and hand probe, and a Teflon piston inserted after a small piece of compressed vein, removed from the back of the hand, is interposed. Results with this technique of operation have been good, with permanent closure of the air-bone gap in 90% and further hearing loss in no more than 1%. The computer system for collecting and analyzing the data from the operation and the postoperative hearing results will be explained, together with the most important complications, how to avoid them, and how to manage them if they occur. A VHS videotape of the course will be distributed to all who attend.
Volume 112 Number 5
Instruction Courses--Sunday P67
initial consultation, billing, informed consent, treatment, complications, and poor results. The course is completely updated yearly to keep the material current.
COURSE 1841 - 1
One-period course ($20)
Room NOCC-104 4:15-5:15
Stapedectomy with Vein Graft and Teflon Piston JOHN J. SHEA,JR., MD
Memphis, Tenn. COURSE 1840-1
One-period course ($20)
Room NOCC- 103 4:15-5:15
Performance a n d M a n a g e m e n t of Long-Term Tracheostomy ISAAC ELIACHAR, MD, and FRANKMILLER, MD
Cleveland, Ohio, and Andrews AFB, Md.
Educational objectives: To determine the indications of performing long-term tracheostomy, better understand the advantage, pitfalls, complications, etc., and to plan and perform this surgical procedure and become knowledgeable in the postoperative management. Long-term flap tracheostomy (LTT) has been advocated to manage longstanding upper airway obstruction. This surgical procedure creates a short, self-staining, completely healed, skin-lined tract between the tracheal mucosa and the anterior skin of the neck. Indications include bilateral vocal cord paralysis or fixation, laryngeal or tracheal stenosis, severe obstructive sleep apnea, intractable aspiration, chronic lung disease and more. This course will demonstrate how the establishment of LTT may be the beginning of a rational, fully thought out and properly executed management of chronic upper airway disease and obstruction. Contrary to frequently encountered experience, LTT is the beginning of a prolonged recovery and maintenance rather than an end procedure performed in severely diseased and hopeless cases. This course will review the surgical technique and the extensive experience for the performance and management of LTT developed at the Cleveland Clinic Foundation. It will include the use of specially designed tracheostomal stents to prevent or minimize the long-term complications associated with the standard curved tracheostomy tube. Once optimal postoperative healing is achieved, the patients enjoy a post laryngectomylike tracheastoma, which may be either maintained with no tube at all or through the application of a readily introduced, self-retaining tracheostomy stent, providing a oneway valve for voice production. Normal or optimal voice has been shown to be preserved throughout a very extensive follow-up. The course will demonstrate the pitfalls, potential side effects and complications. LTT carries significant advantages over standard tracheostomy. It is well tolerated and effective in the treatment of multiple chronic airway diseases.
Educational objectives: To know how to recognize otosclerosis, which patients to operate on, and how toperform a stapedectomy. Otosclerosis is a progressive disorder of the temporal bone that causes ankylosis o f the stapes footplate and conductive hearing loss. It begins in early adult life, is familial, with a recessive tendency, and is believed to be aggravated by pregnancy. It usually begins in the fissura ante fenestra, just in front of the oval window, as a remodeling of bone that enlarges and eventually invades and fixes the stapes footplate. The diagnosis is made by the typical history of a progressive, low-tone conductive hearing loss, often with a family history of similar hearing loss, and a type A tympanogram, with an absent stapedial reflex. Surgical treatment is aimed at making a small opening in the center of the footplate and reconstructing the sound-conducting mechanism of the middle ear. The surgical technique and postoperative care are described in detail. In ears with localized or widespread otosclerosis, narrowing the oval window and even obliterating the edges, a small fenestra is made in the thin central part of the footplate with an argon laser and hand probe, and a Teflon piston inserted after a small piece of compressed vein, removed from the back of the hand, is interposed. Results with this technique of operation have been good, with permanent closure of the air-bone gap in 90% and further hearing loss in no more than 1%. The computer system for collecting and analyzing the data from the operation and the postoperative hearing results will be explained, together with the most important complications, how to avoid them, and how to manage them if they occur. A VHS videotape of the course will be distributed to all who attend.