Intraoperative relationship of the spinal accessory nerve to the internal jugular vein: variation from cadaver studies.

PURPOSE: Conflicting locations of the spinal accessory nerve (SAN) with respect to the internal jugular vein (IJV) are reported in the literature and anatomy texts. The objective of this study is to analyze this anatomic relationship specifically at the level of the posterior belly of the digastric muscle where it is encountered most often during surgery. MATERIAL AND METHODS: This study is a case series with planned chart review of all operative reports for neck dissections/explorations performed between June 2002 to June 2008 at an academic tertiary care referral center. Inclusion criteria required intraoperative identification of the SAN at the level of the posterior belly of the digastric muscle. Patients undergoing revision neck dissection were excluded. Data is presented using descriptive statistics. RESULTS: One hundred ninety-seven patients were identified; 175 met inclusion criteria. Thirty-two patients received bilateral neck dissections/explorations, resulting in a total of 207 SANs for analysis. The most common location of the SAN was lateral to the IJV (198; 95%). In 6 (2.8%) cases the SAN was identified medial to the IJV and 2 nerves pierced the IJV. A new variant of the SAN splitting around the SAN was identified. CONCLUSION: The majority of SANs course lateral to the IJV at the level of the posterior belly of the digastrics muscle (95%). This intraoperative finding differs from cadaveric studies. Discrepancies may reflect variation in the level at which the nerve was identified, as well as tissue changes related to cadaver versus in vivo studies.

Antibiotic resistance and otomycosis in the draining ear: culture results by diagnosis.

OBJECTIVE: The objective of the study was to better define changes in the bacteriology of suppurative otitis in recent years and the role of cultures in the management of these patients. STUDY DESIGN: A retrospective review was performed. METHODS: Outpatient records from 170 patients collected over 3 years with information regarding the bacteria cultured, antibiotic resistance, and clinical diagnosis were analyzed. RESULTS: A large variety of organisms were seen, with Staphylococcus aureus, Corynebacterium sp, and Pseudomonas aeruginosa being the most common. Forty percent of cultures showed bacteria with moderate antibiotic resistance, whereas 5% were sensitive to only intravenous antibiotics. Resistant bacteria were found in all diagnosis categories and were significantly higher in cases of chronic mastoiditis. The rate of methicillin-resistant S aureus infections was 7.8% and was significantly higher in cases of chronic myringitis. Fungus was often cultured in patients without clinical signs of otomycosis. CONCLUSIONS: Community-acquired ear infections may be caused by antibiotic-resistant bacteria in a substantial number of patients. In our opinion, outpatient cultures play an important role in the management of suppurative otitis.

Improved function of prototype 4.3-mm Medtronic Quadcut microdebrider blade over standard 4.0-mm Medtronic Tricut microdebrider blade.

OBJECTIVE: Test performance of a new prototype microdebrider blade. The commercially-available, standard 4.0-mm Medtronic straight Tricut blade was tested against the new, prototype 4.3-mm Medtronic straight Quadcut blade in experimental surgical conditions utilizing both a nasal polyp (NP) analog (raw oysters) and an allergic fungal sinusitis (AFS) analog (minced beef cat food). METHODS: Both sides of 5 thawed, fresh-frozen cadaver heads were utilized for NP analog removal. AFS analog was removed out of specimen containers. A total of 10 paired data points were collected for time of surgical removal and number of clogs comparing the 2 blades. RESULTS: For simulated AFS debris, the prototype clogged less than the standard blade (0 vs 4.5, p < 0.0001). There were no clogs noted for either blade with the NP analog. Time for debris eradication was significantly improved for both AFS analog (147.4 vs 262.0 seconds, p < 0.0001) and NP analog (43.7 vs 112.1 seconds, p < 0.0001). CONCLUSION: The prototype blade offers faster debris and polyp removal and clogs less in the setting of allergic fungal debris. As the new blade is faster and more aggressive, introduction into a surgical setting should be guarded with an appropriate degree of caution.