The Laryngoscope
-
Comparative Study
Anatomical and computed tomographic analysis of the transcochlear and endoscopic transclival approaches to the petroclival region.
Advances in the field of skull base surgery aim to maximize anatomical exposure while minimizing patient morbidity. The petroclival region of the skull base presents numerous challenges for surgical access due to the complex anatomy. The transcochlear approach to the region provides adequate access; however, the resection involved sacrifices hearing and results in at least a grade 3 facial palsy. An endoscopic endonasal approach could potentially avoid negative patient outcomes while providing a desirable surgical window in a select patient population. ⋯ Endoscopic access to the petroclival region is a feasible approach. It potentially avoids hearing loss, facial nerve manipulation, and cosmetic damage.
-
Comparative Study
Pediatric temporal bone fractures: current trends and comparison of classification schemes.
1) Characterize the current presentation of pediatric temporal bone fractures, 2) compare two classification schemes for temporal bone fractures and illustrate complications in each fracture type. ⋯ In this pediatric series, approximately 75% of the fractures are longitudinal and 25% are transverse. The otic capsule is spared in 90% and violated in 10%. Both OCS/OCV and L/T classification schemes predict SNHL, but the OCV/OCS scheme is more accurate in this prediction. Although the negative predictive value of the two schemes is similar, the positive predictive value is higher with the OCS/OCV system. The presence of conductive hearing loss and facial nerve symptoms was not predicted by either classification system.
-
Free tissue transfer has success rates greater than 95%. Approximately 10% will require reexploration for vascular compromise. Return to the operating room within 48 hours yields the highest rate of successful salvage. Our aim was to determine whether an implantable Doppler used for intraoperative/postoperative monitoring would 1) alter the pattern of detecting flap failure and 2) alter the overall incidence of flap survival. ⋯ Intraoperative Doppler's increase the detection of immediate/incipient vascular problems. Patients requiring revision in the operating room require revision more often in the postoperative period (P = .03) and are less likely to have successful salvage and a lower flap survival rate (P = .05).
-
To evaluate the endoscopic surgical management of adult subglottic stenosis and describe treatment outcomes. ⋯ Subglottic stenosis remains a treatment challenge. Although patients are often symptomatically improved after endoscopic dilation, recurrence rates remain high.