Combined endoscopic medial and external lateral orbital decompression for progressive thyroid eye disease.

OBJECTIVE: To compare the efficacy of endoscopic medial and lateral orbital wall surgery to 3-wall decompression in patients with thyroid eye disease. STUDY DESIGN AND SETTING: A retrospective study of patients with thyroid eye disease with severe proptosis, exposure keratitis, or compressive optic neuropathy was conducted. RESULTS: Mean reduction in proptosis was 4.37 mm in the 2-wall approach and 4.59 mm in the 3-wall group. Seventy-five percent of patients in the 2-wall group demonstrated improved visual acuity; 50% improved after 3-wall decompression. Vertical palpebral fissure height decreased by an average of 2.50 mm in the 2-wall group and by 2.03 mm in the 3-wall group. New onset diplopia was 11.8% and 12.5%, respectively. CONCLUSIONS: Improvement in the degree of proptosis, visual acuity, and palpebral fissure height was seen in the majority of our patients and compared favorably to our results with 3-wall orbital decompression.

High-resolution magnetic resonance imaging of human cochlea.

OBJECTIVES: High-resolution MRI (MRI) of human inner ear structures provides several advantages over other imaging modalities. High-resolution visualization of inner ear ultrastructure in a noninvasive manner may provide important information about inner ear disease that is not obtainable in other ways. The study was performed to demonstrate the capabilities of MRI at high resolution on the human cochlea, vestibular structures, and facial nerve. Comparative analyses of MRI anatomy with that seen on histological dissection were made. The aim of the study was to define the anatomy of human cadaveric cochlea using a 9.4-Tesla magnetic resonance scanner, currently the most powerful magnetic resonance magnet available. STUDY DESIGN: Experimental pilot study of cadaveric human cochleae. METHODS: Serial scanning using a 9.4-Tesla magnetic resonance imager on normal preserved and fresh cadaveric inner ears was performed in different planes. RESULTS: The images revealed detailed anatomy of the modiolus, utricle, saccule, semicircular canals, and facial nerve. Specifically, identifiable structures within the cochlea included the osseous spiral lamina, Reissner's membrane, membranous spiral lamina, spiral ligament, and others. CONCLUSIONS: Data established through the acquisition of images from cadaver cochlea, facial nerve, and vestibular complex provide a foundation for developing steps for testing temporal bones and, eventually, patients with Meniere's disease and other inner ear disease. The present ongoing project will provide information on baseline images of the inner ear using high-resolution MRI.

Diagnosis and management of pulmonary metastasis from recurrent respiratory papillomatosis.

OBJECTIVE: We sought to review the current and proposed management, as well as bring about discussion, of managing the patient with distal tracheal and pulmonary parenchymal involvement by recurrent respiratory papillomatosis (RRP). DESIGN, SETTING, AND PATIENTS: We conducted a review of 6 patients with pulmonary metastasis from RRP at 3 academic tertiary care hospitals. Interventions included surgical and medical management with antiviral, chemotherapeutic, and/or immune-modulating agents. RESULTS: Although treatment with alpha-2-beta interferon, isotretinoin, and methotrexate have not proved to eradicate pulmonary involvement by RRP, possible epithelial stabilization and slowing of disease progression are noted. CONCLUSIONS: The rates of distal tracheal and pulmonary metastasis as seen in our cohort were higher than previously reported. Approximately 12% of our patients with RRP have distal tracheal spread and as many as 7% of all patients with RRP at our institutions have pulmonary dissemination. Also, high suspicion for malignant conversion to squamous carcinoma in the patient with pulmonary spread should be maintained. In addition, aggressive treatment, although not proved to eradicate the pulmonary disease, should be undertaken due to the high morbidity and mortality associated with pulmonary dissemination of RRP in our cohort.