Biplanar superficial musculoaponeurotic system imbrication rhytidectomy.

Rhytidectomy techniques have evolved significantly since the procedure's introduction in the early 20th century. Significant advancements in rhytidectomy techniques occurred in the 1960s and 1970s with the description of the subfascial rhytidectomy, the identification of the superficial musculoaponeurotic system (SMAS), and development of the SMAS flap. The incorporation of fascial undermining and suspension techniques have significantly improved the longevity and natural appearance of the facelift operation. More aggressive techniques including subperiosteal, composite, and deep plane techniques have been developed in the pursuit of the perfect facelift procedure. On the basis of over 25 years of clinical and surgical experience, a biplane SMAS imbrication rhytidectomy provides a natural, unstretched, and refreshed appearance resulting in high patient satisfaction. This article will present a detailed description of the rationale, technique, and nuances of the biplanar SMAS imbrication rhytidectomy. While the management of the platysma may vary depending on individual patient characteristics, the extent of subcutaneous, sub-SMAS, and neck dissection employed using the biplanar SMAS imbrication rhytidectomy minimizes patient complications and allows a relatively rapid recovery.

Evaluation of pediatric sensorineural hearing loss: a survey of pediatric otolaryngologists.

OBJECTIVES: We sought to determine the trends in the evaluation of pediatric patients with sensorineural hearing loss (SNHL) and to determine evaluation patterns based on respondents' demographic data. METHODS: All members of the American Society of Pediatric Otolaryngology were invited to voluntarily and anonymously complete an online survey. The survey was available from September 2009 to January 2010 and addressed demographic data and tests obtained in evaluating new pediatric patients with SNHL at different age points and with different degrees of hearing loss. RESULTS: The response rate was 22.9% (79 of 345). For all ages and all types of SNHL, the most common consultations were genetics (26% to 76%) and ophthalmology (31% to 66%) consultations. Computed tomography of the temporal bones (49% to 66%), genetic testing (25% to 68%), and electrocardiography (13% to 43%) were the most commonly performed tests. Although there was no consistent difference in practice patterns by gender or years of practice, there were differences in the use of thyroid function tests, TORCH titers, and autoimmune studies by hospital affiliation. CONCLUSIONS: Type of SNHL and age are factors in the evaluation of pediatric patients with SNHL. Additionally, evaluation patterns differ according to region and hospital affiliation. The results of this study may provide guidance for otolaryngologists in making information-based and cost-effective evaluations.

Auditory function after application of ototopical vancomycin and mupirocin solutions in a murine model.

OBJECTIVE: To determine whether mupirocin (440 µg/mL) and vancomycin otic drops (25 mg/mL) show evidence of ototoxicity in CBA/J mice immediately following a 7-day course of daily intratympanic (IT) injections and 1 month following treatment. STUDY DESIGN: Nonrandomized controlled trial. SETTING: Academic hospital laboratory. SUBJECTS: Twenty CBA/J mice. RESULTS: Mean auditory brainstem response (ABR) thresholds increased in all drug- and saline-treated ears immediately after 7 days of IT injections but returned to baseline for most stimulus frequencies by 30 days later. This finding appeared to be correlated with the presence and subsequent resolution of tympanic membrane (TM) perforations and granulation tissue at the injection sites. Mupirocin-treated ears showed no significant difference in ABR thresholds compared to saline-treated ears. No significant differences were noted between vancomycin- and saline-treated ears, but there was a significant interaction between testing day and stimulus frequency (P < .001). Further analysis revealed that ABR thresholds at 32 kHz remained significantly elevated in vancomycin-treated mice despite the resolution of TM perforations and granulation tissue 30 days after completion of IT injections (95% confidence interval, -13.5 to -5.5, P < .01). CONCLUSION: Although IT application of mupirocin solution (440 µg/mL) caused no significant change in the ABR thresholds in a murine model, vancomycin solution (25 mg/mL) resulted in high-frequency threshold elevations in both the ear directly injected and the contralateral ear. Mupirocin solution may be beneficial in managing otitis externa and media caused by resistant pathogens. Further studies of ototopical vancomycin are needed to define parameters governing its safe use.

Endoscopic resection of maxillary sinus inverted papillomas with inferior turbinate preservation.

The surgical management of inverted papillomas of the maxillary sinus has evolved from large en block excisions requiring external incisions to the minimally invasive endoscopic and endoscopic-assisted techniques used today. The traditional endoscopic approach involves resection of the inferior turbinate to perform an endoscopic medial maxillectomy, which can cause atrophic rhinitis and shrinking of the maxillary sinus, resulting in difficulty following these patients for recurrence in the office. In this article, we present a series of patients who underwent a modified endoscopic surgical approach for the excision of maxillary sinus inverted papillomas. In our approach, we preserve the inferior turbinate to preserve nasal mucosa physiology. Patient characteristics, recurrence rates, and complications associated with this approach are reviewed.

Hemangiomas of the external auditory canal.

Hemangiomas of the external auditory canal are rare with only 16 cases reported in the literature. We report the case of a 62-year-old woman who presented with bleeding from the external auditory canal. Physical examination and imaging were consistent with a hemangioma. Initial diagnostic evaluation failed to reveal the full extent of the lesion resulting in recurrence after primary local excision. After recurrence, the hemangioma was managed successfully with embolization and a more extensive resection. In addition, we review the relevant literature with respect to epidemiology, presentation, evaluation, pathology, and management options for hemangiomas arising in the external auditory canal.