Clinical Study of Second Branchial Cleft Anomalies

Objective: The objective of this study was to review the clinical characteristics and surgical treatment outcomes of second branchial cleft anomalies, and to evaluate the usefulness and accuracy of preoperative fine-needle aspiration cytology (FNAC) in the diagnosis of branchial cleft cysts. Methods: A retrospective chart review was performed at Chonnam National University Hwasun Hospital from January 2010 to December 2016. Results: Among 25 patients with second branchial cleft anomalies, in 23 patients (92.0%), these anomalies presented as cysts, and in the remaining 2 patients (8.0%), these anomalies presented as fistulas. Fine-needle aspiration cytology had a diagnostic sensitivity of 100%, a positive-predictive value of 100%, and accuracy of 100% for diagnosing second branchial cleft cyst. All patients of second branchial cleft anomalies were treated surgically under general anesthesia. No recurrence of second branchial cleft anomalies was observed. Conclusion: Branchial cleft cysts were the most common type of second branchial cleft anomalies. Preoperative FNAC is a useful and accurate method for preoperative evaluation of branchial cleft cysts. Surgical excision of second branchial cleft anomalies is the treatment of choice without any complications and with no recurrence. Address correspondence and reprint requests to Joon Kyoo Lee, MD, PhD, Department of Otolaryngology—Head and Neck Surgery, Chonnam National University Medical School and Hwasun Hospital, 160 Ilsimri, Hwasun, Jeonnam 519-809, South Korea; E-mail: joonkyoo@jnu.ac.kr; Dong Hoon Lee, MD, PhD, Department of Otolaryngology—Head and Neck Surgery, Chonnam National University Medical School and Hwasun Hospital, 160 Ilsimri, Hwasun, Jeonnam 519-809, South Korea; E-mail: leen3l@hanmail.net Received 14 June, 2017 Accepted 12 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Cavernous Sinus Aneurysm Associated With Cerebellar Hemangioblastoma in an Adult With von Hippel-Lindau Disease

A case of cerebellar hemangioblastoma with von Hippel-Lindau disease and an aneurysm of the cavernous sinus segment of the internal carotid artery is presented here. A 60-year-old woman presented with a cerebellar solid tumor manifesting as headache of 4 months, progressive vomiting, and ataxia of half a month. Four-vessel angiography revealed a high stain mass tumor located in the posterior fossa; an aneurysm on the cavernous sinus segment of the internal carotid artery was demonstrated at the same time. The ipsilateral anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) branches were the main feeding vessels of the hemangioblastoma. The patient underwent left-lateral suboccipital craniectomy to remove the highly vascular hemangioblastoma. Successful total excision of the tumor was demonstrated on postoperative magnetic resonance (MR) images. The unruptured cavernous sinus aneurysm in this case was not on the feeding artery, which was asymptomatic and has not been treated further. The patient was in good condition in 1-year follow-up. Address correspondence and reprint requests to Kui Ma, MD, Department of Neurosurgery, Lianyungang Hospital, Affiliated to Xuzhou Medical University, Hai Zhou District, Lianyungang, China; E-mail: 17714156318@163.com Received 22 January, 2018 Accepted 13 February, 2018 HZ and SS contributed equally to this article. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Cleft Palate Repair Using Single Flap Palatoplasty in Patient With Associated Palatal Hemangioma

Hemangiomas are the most common tumors of childhood with an average incidence of 10%. It is unusual for hemangiomas, which are already rarely seen isolated on the palate, to coexist with cleft palate as in the authors' patient. Four months old baby was admitted with isolated Veau 2 cleft palate and a red-purple colored raised lesion involving almost the whole right side of the hard palate. Magnetic resonance imaging revealed intensive contrasting solid nodule with a lobulated contour that was covering the right half of the hard palate, measuring 2.2×1.3 cm. To reduce the size of the vascular lesion 7 mg/d oral propranolol treatment was initiated. Following reduction in the size of hemangioma, the cleft palate was repaired at 11 months of age. Single mucoperiosteal flap from the left side of the palate preserving the major palatine artery was elevated whereas right mucoperisteal flap was minimally dissected not to interfere with the hemangioma. No intraoperative and postoperative complications in both the early and late term were experienced. As a result, since early palatal repair is important to obtain ideal speech outcomes in cleft patients, repair should be performed in similar patients with hemangiomas without delaying the timing. Address correspondence and reprint requests to Mert Calis, MD, Febopras, Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Hacettepe University, 06100 Sihhiye, Ankara, Turkey; E-mail: mertcalis@gmail.com Received 19 October, 2017 Accepted 14 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Percutaneous Autologous Fat Injection Following 2-Layer Flap Lower Blepharoplasty for the Correction of Tear Trough Deformity

Tear trough deformity has been an area that has received much attention in terms of esthetic improvements. Fat transposition has been commonly used for the treatment of tear trough deformity. As some patients have had minimal improvement by that method, we propose the use of fat grafting combined with open blepharoplasty to complement the sunken area, including some of anterior maxilla region, and evaluate and precisely remove the excessive tissue. Lower blepharoplasty was performed by separating the skin and muscle flap. The excessive or laxed tissue was evaluated during the procedure and resected in each flap. Fat grafting was performed after completing a lower blepharoplasty, to ensure accurate placement on the spot where the surgeon originally intended. Overcorrection is not recommended. No serious complications were reported during a period of 10 years. Only 4 patients required a secondary fat injection. Patients who require structural correction of the lower eyelid area (eg, aggressive herniated fat, excessive skin laxity, or bulky orbicularis oculi muscle) and who need complementary material to fill the lower lid area (eg, deep, wide sunken area or relative exophthalmos) are good candidates for blepharoplasty with a fat grafting procedure. Address correspondence and reprint requests to Hyungon Choi, MD, PhD, Department of Plastic Surgery, Konkuk University School of Medicine, Seoul, Korea, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 143-729, Korea; E-mail: sweetestfairy@hanmail.net Received 4 December, 2017 Accepted 14 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Outcomes After Open Reduction With Internal Fixation of Mandible Fractures

Introduction/Hypothesis: Mandible fractures contribute substantially to morbidity after blunt trauma. Controversy exists surrounding the appropriate timing of surgical intervention and benefit from routine postreduction imaging. Methods: The authors retrospectively reviewed 146 patients who sustained traumatic mandible fractures at a level 2 trauma center over a 5-year period, between January 2012 and December 2016. The authors excluded all patients who did not undergo surgery, underwent operative closed reduction only, sustained other significant maxillofacial injuries, penetrating mechanisms, and other major injuries based on injury severity scores (ISS) over 15. There were 51 patients meeting inclusion criteria. The authors reviewed admission face computed tomography (CT) scans and Panorex x-rays. Patients were divided into early (72 hours) open reduction with internal fixation (ORIF) groups. The authors reviewed demographics, mechanism of injury, postreduction imaging, and ISS. All statistical analyses were performed using Stata 15. Results: There were 39 males (76%) and 12 females (24%) in the authors' study, with a mean age of 32 years. Twenty-eight patients (55%) underwent early ORIF and 23 patients (45%) underwent late ORIF, with no mortalities. There was no statistically significant difference in ISS between the 2 groups (P = 0.081). Preoperative face CT scans were performed in 49 patients (96%) and Panorex in 2 patients (4%). Eight patients (16%) had both modalities, with CT face identifying fractures in 5 patients not seen on Panorex, resulting in a change in operative approach. Postreduction imaging was obtained in 33 patients (65%), of whom 26 were Panorex X-rays. These demonstrated adequate reduction in 31 patients (94%) and did not change management in any instance. Complications occurred in 19 patients (37%), of whom there were 11 with uncontrolled pain after 1 week, 6 abscesses, 5 nonunions/malunions, 2 hardware extrusions, and 1 incisional dehiscence. A positive urine drug screen predicted uncontrolled pain (P  72 hours do not appear to increase complication rates. Address correspondence and reprint requests to Rahman G. Barry, MD, Department of Surgery, Marshall University, 1600 Medical Center Dr., Huntington, WV 25701; E-mail: rahmanbarry@gmail.com Received 15 November, 2017 Accepted 14 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Cardiac Arrest and Death Attributable to the “Diving Response” Triggered During Incision and Debridement of an Abscess of the Forehead

The authors discuss about a patient who, while undergoing a routine procedure to drain a subcutaneous abscess within his forehead, suffered cardiac arrest that we conclude was caused by an activation of the diving response. This reflex affects homeostatic function which alters respiration and preferentially distributes oxygen stores to the heart and brain. Under some conditions, however, this reflex can also trigger cardiovascular collapse and death. The diving reflex is can begin with triggering receptors that are sensitive to cold water, submersion, or pressure within the nasal cavity and other areas supplied by the trigeminal nerve. Studies have shown that this afferent response primarily involves branches of the infraorbital nerve and the anterior ethmoidal nerve. However, other more superior nerves such as those exclusive to the forehead region may also be involved. This study demonstrates for the first time the risks and dangers involved in surgical procedures or manipulation of the trigeminal innervated areas of the human face and in particular the forehead. Address correspondence and reprint requests to Steven M. Kane, MD, 320 Parkway Drive NE, Suite 300, Atlanta, GA 30312; E-mail: Steve.Kane@wellstar.org Received 20 December, 2017 Accepted 14 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Sex Difference in the Morphology of Pineal Gland in Adults Based on Brain Magnetic Resonance Imaging

Purpose: We aimed to figure out the anatomical features of pineal gland region on magnetic resonance imaging (MRI) and to explore the sex difference in pineal gland-related parameters with increasing age. Methods: We measured the pineal gland on MRI images from 198 healthy adults (96 males and 102 females). Included subjects were divided into 4 age groups. After 3-dimensional reconstruction, the anatomic features of pineal gland and its distances to superior colliculus and splenium of corpus callosum were analyzed in each group. The prevalence of cystic pineal gland was calculated. Moreover, we calculated the volume of pineal gland (PGV) and explored the differences of PGV in males and females across different age groups. Linear regression analysis was performed to detect the relationship between age and pineal gland-related parameters. Results: In 198 subjects, the mean length, width, and height of pineal gland were 7.58 ± 0.45 mm, 4.92 ± 0.40 mm, and 2.90 ± 0.20 mm. The distances between pineal gland and superior colliculus as well as splenium of corpus callosum were 3.96 ± 0.92 mm and 4.3 ± 1.89 mm, respectively. The PGV was 54.1 ± 7.02 mm3. Significant sex differences were found in pineal gland length (P 

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Comparison of Outpatient and Inpatient Pediatric Rhinoplasty: Results From National Surgical Quality Improvement Program–Pediatric, 2012–2014

Introduction: Outpatient management of patients undergoing elective surgical procedures has been associated with significantly decreased health care costs compared with inpatient management. This study investigates current practices in outpatient versus inpatient management of pediatric rhinoplasty patients. Methods: A query was performed of the 2012 to 2014 National Surgical Quality Improvement Program–Pediatric data sets. Patients age 17 or younger undergoing rhinoplasty as the primary surgical procedure were included. Clinical characteristics and complications were compared among patients managed as inpatients versus outpatients using both univariate and multivariate logistic regression analyses. Results: Among 938 pediatric rhinoplasty patients, 199 (21.2%) were managed as inpatients. Multivariate analysis revealed multiple variables significantly associated with an increased odds of inpatient management, including young patient age, presence of a congenital malformation, neurologic or nutritional disease, lengthy procedure time, management by a plastic surgeon compared with an otolaryngologist, and certain procedure types including cleft septorhinoplasty, secondary rhinoplasty with intermediate or major revision, and rib cartilage grafting. Complications among both inpatients and outpatients were rare, with the most common complication being readmission among 15 patients (1.6%). Conclusions: This study indicates that multiple subgroups of pediatric patients undergoing rhinoplasty procedures have a significantly increased likelihood of inpatient management without any significantly increased likelihood of a complication or need for readmission. Future efforts to manage appropriately selected children on an ambulatory basis may be safe, while improving costs and quality of care. Address correspondence and reprint requests to Ravi K. Garg, MD, Division of Plastic and Reconstructive Surgery, University of Wisconsin, Madison, WI 53792; E-mail: rgarg@uwhealth.org Received 2 December, 2017 Accepted 15 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Orbital Fracture Reconstruction Using Prebent, Anatomic Titanium Plates: Technical Tips to Avoid Complications

Orbital fractures are common. In patients where there is significant loss of the medial wall and orbital floor, anatomic prebent 3-dimensional plates allow efficacious restoration of orbital volume. However, the large size of these plates can result in technical difficulties with plate placement, especially in fractures with complete loss of 2 walls of the orbit. In this article, the authors review the pertinent anatomy of the bony orbit with respect to fracture and landmarks in fracture reduction. The authors also note the 3 most commonly encountered problems with the placement of anatomic plates: poor exposure, failure to identify the posterior ledge for the plate, and rotational issues with plate placement resulting in impingement. Technical tips are given to help overcome these issues intraoperatively. Address correspondence and reprint requests to Chad A. Purnell, MD, Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, 675N St Clair Street, Suite 19-250, Chicago, IL 60611; E-mail: chadpurnellmd@gmail.com Received 25 November, 2017 Accepted 16 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Bilateral Post-Traumatic Facial Paralysis That Contains Longitudinal and Transverse Temporal Fracture

Acute bilateral post-traumatic facial paralysis is rare in the literature. Post-traumatic facial paralysis is frequently accompanied transverse fractures of temporal more. The incidence of acute bilateral post-traumatic facial paralysis has been reported as 1 to 5 per million in the literature. Trauma and concurrent facial paralysis are usually in the same subsite (right temporal bone fracture and right facial paralysis). There is one pathophysiological pattern for a single temporal bone fracture in a subsite. The authors present a bilateral isolated different pathophysiological pattern sudden onset facial paralysis in a patient herein. Address correspondence and reprint requests to Caner Şahin, MD, Ear Nose and Throat Department, Alanya Alaaddin Keykubat University, Antalya, Turkey; E-mail: drcaner2001@gmail.com Received 2 January, 2018 Accepted 9 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Posterior Fossa Re-Exploration for Recurrent Trigeminal Neuralgia: Operative Findings and Surgical Techniques

Objective: Microvascular decompression (MVD) is considered the first choice for the surgical treatment of trigeminal neuralgia (TN). However, recurrence after MVD is still a problem and a challenge for neurosurgeons. In this study, we share our experience in the posterior fossa re-exploration of the recurrent cases. Methods: From January 2014 to January 2015, 15 recurrent TN patients who received fossa re-exploration were retrospectively studied. Surgeries were performed by retrosigmoid suboccipital approach. Brainstem auditory evoked potentials (BAEP) were monitored throughout the operation. Intraoperative findings and surgical techniques were recorded. Postoperative outcomes and complications were analyzed. Results: Among the 15 patients, Teflon adhesion was found in 14. Teflon felt displacement was found in 4 patients, and additional Teflon felt was used to interpose. New offending vessels were found in 5 patients. Three of them were small arteries and the other 2 were petrosal veins. After dissected, small pieces of wet gelatin sponge and Teflon felt were implanted respectively to ensure complete decompression. The remaining 6 patients had no vascular compression except severe adhesion, and nerve combing was performed. After surgery, 12 achieved complete pain relief, 2 gained partial pain relief, and 1 failed. Six patients experienced facial numbness postoperatively. There was no hearing impairment or other complications. During the mean 26-month follow-up, no recurrence occurred and all of 6 cases with facial numbness after surgery improved. Conclusions: Teflon adhesion is a significant cause of recurrent TN. Wet gelatin-assisted method is good for Teflon interposition. If no vascular compression is found during re-exploration, trigeminal nerve combing can be used. Intraoperative BAEP monitoring is helpful to reduce the incidence of hearing loss. Address correspondence and reprint requests to Shi-Ting Li, MD, PhD, Department of Neurosurgery, Xin Hua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai Jiao Tong University School of Medicine, 1665 KongJiang Rd., Shanghai 200092, China; E-mail: lsting66@163.com Received 19 January, 2018 Accepted 8 February, 2018 Supported by a grant from Shanghai Jiao Tong University cross fund for medical engineering (#YG2016QN68, to Bao-hui Feng). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Rare Cause of Tinnitus: Spontaneous Temporomandibular Joint Herniation Into the External Auditory Canal

The herniation of temporomandibular joint (TMJ) into external auditory canal (EAC) may occur due to trauma, neoplastic, infectious, and inflammatory processes. On the other hand, spontaneous herniation of TMJ into EAC is an extremely rare conduction and occurs as a consequence of patent retention of foramen of Huschke (FH). Patent FH is usually an asymptomatic situation. In this article, a patient having otologic symptoms as a result of spontaneous herniation of TMJ into EAC was presented in the light of current literature. Address correspondence and reprint requests to Suha Ertugrul, MD, Sirinevler Mahallesi, Alpaslan Caddesi, no 1, Merkez, Karabuk, Turkey; E-mail: drsuhaertugrul@hotmail.com Received 31 October, 2017 Accepted 26 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Evaluation of Facial Anthropometry Using Three-Dimensional Photogrammetry and Direct Measuring Techniques

In this study, 14 standard facial distances on 10 adult volunteers were measured directly with a caliper and indirectly on two-dimensional images using the 3dMDtrio system. Two raters performed the measurements with at least 1 week between rating sessions. The intra- and inter-rater reliabilities and agreement of the measurements were calculated using intra-class correlation coefficient (ICC), mean absolute difference (MAD), and Bland-Altman plots with limits of agreement (LOA). The 2 raters had an average discrepancy (MAD) of 1.6 mm when their digital measurements were compared to their direct measurements. The reliability of the digital and direct methods varied greatly depending on which of the 14 anthropometric distances that was being assessed. Only 6 digitally and 5 directly measured anthropometric distances showed both an ICC >0.75 and a MAD

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New Rhizotomy Procedure for Primary Spasmodic Torticollis

Objective: Spasmodic torticollis (ST) is an idiopathic neurologic disorder affecting the muscles of the neck. Surgery is a preferred treatment, when conservative treatments or Botulinum neurotoxin injections fail to relieve the symptoms. Our objective here is to report the outcome of a new surgical method for treating ST patients in our department. Methods: The new procedure consists of rhizotomy of the spinal accessory nerve (SAN) and C1–C2 nerve roots, coagulation of the distal end of SAN (Group A). The results of this procedure were compared with a group of patients who underwent only rhizotomy of the SAN and anterior C1–C2 nerve roots (Group B). Clinical data were retrospectively collected from 39 patients with laterocollis and rotatory torticollis subtypes of ST from Jun 1, 2014 to Jun 1, 2015. The effect of the surgery was evaluated by the reduction in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total scores preoperatively and postoperatively. The mean duration of the postoperative follow-up period was 2.57 years, ranging from 2 to 3 years. Results: The mean preoperative TWSTRS score was 65.89 ± 3.55 and 65.80 ± 3.45 in Groups A and B, respectively. Six months after the surgery, the TWSTRS scores decreased to 40.00 ± 12.14 and 26.04 ± 11.77, respectively. There was a statistically significant improvement preoperatively and postoperatively in both groups (P 

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Patient-Reported Quality of Life in the Highest Functioning Patients With Treacher Collins Syndrome

Background: Treacher Collins syndrome has a wide variation of clinical presentation, including airway obstruction and hearing loss. The objective of this study was to assess patient-rated quality of life in Treacher Collins syndrome, who received multidisciplinary treatment at a specialized craniofacial hospital, and to compare their quality of life with a control sample. Methods: Treacher Collins patients under treatment in a multidisciplinary setting were assessed with the World Health Organization Quality of Life (WHOQOL-100) questionnaire. The Siviero scale was used to classify quality of life as unsatisfactory (scores below 25), intermediate (scores between 25 and 75), and satisfactory (scores above 75). Quality of life comparison between Treacher Collins patients and 2342 unaffected individuals from a previous database was performed using the analysis of variance test. Differences were considered significant at P 60%) quality of life in almost all WHOQOL-100 facets and domains. The comparison of the scores between unaffected individuals and Treacher Collins patients demonstrated a significant difference (P 

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Hello World – Welcome to The Tox and The Hound

We are excited to launch a new endeavor in collaboration with the EMCrit collective. The Tox and The Hound. A toxicology blog written by toxicologists.

EMCrit Project by Tox & Hound.

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Hello from The Dantastic Mr. Tox &Howard Show

https://ift.tt/2JdAlzF   Join the Dantastic Mr. Tox (@drusyniak) &Howard (@heshiegreshie) as they interview leading scientists and raconteurs about, what else, toxicology. Like a middle linebacker, they tackle the latest topics and controversies. Throw in fake ads and a house band and you get a podcast that the New York Times exclaimed "Mueller probe narrows in […]

EMCrit Project by Tox & Hound.

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“Successful non-invasive treatment of festoons.”

No abstract available

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Reply: Commetary on Primary Septal Cartilage Graft for the Unilateral Cleft Rhinoplasty

No abstract available

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A Hidden legacy of Dr.Ralph Millard, Jr.

No abstract available

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