Arch Otolaryngol
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Tissue expansion is indicated in the reconstruction of various defects of the head and neck in instances where there is inadequate adjacent tissue to allow either primary closure of the defect or repair with a local flap. It may also be indicated in instances where repair of a defect by an alternative method such as a local, regional, or distant flap will result in an unacceptable donor or recipient site deformity. ⋯ The complication rate is high for tissue expansion in the head and neck, particularly in the cheek and neck area. Despite the frequency of complications, in the vast majority of cases the intended reconstruction is successful.
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We describe an unusual brachial plexus anatomical variant that renders it vulnerable to injury in radical or modified neck dissection. It is represented by a looping redundant course of the most cephalad cervical division contribution to the brachial plexus. Unless recognized during development of the inferior surgical plane by blunt dissection techniques, injury to this portion of the brachial plexus may occur. An awareness of this infrequent variation in brachial plexus anatomy should be maintained.
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Uvulopalatopharyngoplasty is the treatment of choice for selected patients with obstructive sleep apnea, although the response to surgery is variable. We measured, in addition to obstructive apnea, the frequency of sleep-related partial upper airway obstruction in 11 patients with the obstructive sleep apnea syndrome both before and after uvulopalatopharyngoplasty. Partial obstruction was detected indirectly by recording the secondary hemodynamic changes and respiratory stimulation with the static charge sensitive bed. ⋯ The various breathing anomalies decreased significantly, although they were still present during 75.6% of the recording time. The results suggest that uvulopalatopharyngoplasty substantially reduces the frequency of obstructive apnea, some of which persists as partial obstruction. The persistent partial obstruction may be the key factor contributing to further pharyngeal narrowing and a recurrence of obstructive sleep apnea syndrome.
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The use of antibiotics in suppurative otitis media has greatly diminished the incidence of complications. Deep neck abscess arising from acute mastoiditis, a disease thoroughly described by Frederick Bezold early in this century, has become rare. In the last three years we have treated five cases of deep neck abscess of otogenic origin at our hospital. ⋯ In four of the cases, delay in diagnosis occurred because of failure to recognize the disorder. Computed tomography has proved valuable in the anatomic diagnosis and surgical planning. Renewed familiarity with the clinical presentations and pathogenesis of this now uncommon condition may prevent delay in diagnosis and initiation of therapy.