Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
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Otolaryngol Head Neck Surg · Mar 2010
Randomized Controlled TrialDiagnostic efficacy of surgeon-performed ultrasound-guided fine needle aspiration: a randomized controlled trial.
To evaluate the clinical efficacy of surgeon-performed, office-based head and neck ultrasound in facilitating diagnostic fine needle aspiration (FNA) of lesions in the head and neck. ⋯ Office-based surgeon-performed ultrasound-guided FNA of palpable lesions in the head and neck yields a statistically significant higher diagnostic rate compared to standard palpation technique. Our institutional experience supports the utility of surgeon-performed ultrasound as a core competency in clinical practice.
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Otolaryngol Head Neck Surg · Mar 2010
Janus flap: bilateral nasoseptal flaps for anterior skull base reconstruction.
Large dural defects after extended endoscopic endonasal skull base resections require meticulous reconstruction to prevent a cerebrospinal fluid leak postoperatively. The nasoseptal flap is a vascularized tissue graft developed to aid in the multilayer reconstruction of the skull base. The purpose of this study is to describe the first experiences with bilateral nasoseptal flaps for reconstruction of very large skull base defects. ⋯ Bilateral nasoseptal flaps are a viable option for large dural defects of the anterior and ventral skull base when one nasoseptal flap may not completely seal the entire defect.
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The ideal hematocrit for patients undergoing free flap reconstruction is unknown. It is standard practice to keep hematocrit levels above 30 percent, although there is evidence that blood transfusions are associated with both infectious and noninfectious complications. We propose that lowering the trigger for postoperative transfusions from 30 percent to 25 percent will not increase flap-related complications and may reduce unnecessary blood transfusions. ⋯ For patients undergoing free flap surgery, a postoperative transfusion trigger of hematocrit < 25 percent decreases blood transfusion rates without increasing rates of flap-related complications.
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Otolaryngol Head Neck Surg · Feb 2010
Propofol-induced sleep: polysomnographic evaluation of patients with obstructive sleep apnea and controls.
The localization of upper airway obstruction in patients with obstructive sleep apnea (OSA) may optimize treatment. Nasoendoscopy during propofol sedation allows such an evaluation, but the effect of this drug on respiratory patterns and muscle relaxation is unknown. The objective of the present study was to determine through polysomnography whether propofol would change sleep parameters. ⋯ These preliminary results allow us to infer that sedation with propofol changes sleep architecture but permits respiratory evaluation, because the main respiratory parameters evaluated in OSA are maintained. These preliminary results support the view that nasoendoscopy under propofol sedation is a promising examination for management of this disease.