Complication of a columellar strut in an edentulous patient.

The cartilaginous columellar strut is a well established, commonly used graft in rhinoplasty which provides support and stability to the nasal base. The risk of such a graft is related to grafts designs, whereby the posterior aspect can cause clicking with movement across the anterior nasal spine. We present an additional unusual complication of ill-fitting maxillary dentures in an edentulous patient, previously not reported in the literature. This unique complication should alert facial plastic surgeons to use additional caution when sculpting columellar grafts in edentulous patients in order to avoid potential post-operative complications in this specific patient population.

Use of AlloDerm in primary reconstruction after resection of squamous cell carcinoma of the lip and oral commissure.

AlloDerm (LifeCell Corporation, Branchburg NJ) is an acellular dermal homograft processed from human cadaveric skin. AlloDerm has been used successfully for soft tissue reconstruction due to its lack of immunogenicity and minimal absorption. In the lip, it has been utilized for aesthetic lip augmentation and as an injectable filler. Description of its usage as an implant in primary lip reconstruction after tumor resection is limited. We describe the case of a 52 year old male with a squamous cell carcinoma of the oral commissure and lower lip. After resection, the defect was reconstructed using implanted AlloDerm for bulk, a buccal mucosal advancement flap, and a cheek rhomboid flap. Lip mobility and oral competence were normal 3 months postoperatively. The reconstruction achieved adequate augmentation without significant resorption. AlloDerm should be considered in primary lip reconstruction after cancer resection.

Safety of cranial fixation in endoscopic brow lifts.

INTRODUCTION: The endoscopic brow lift technique relies on brow mobilization and often soft fixation to the underlying calvarium. While the endoscopic brow lift has been used safely, there are anecdotal reports of cerebrospinal fluid leak. We sought to measure calvarial thickness to improve the safety of cranial fixation. METHODS: A retrospective review was performed of T2 weighted MRIs of the face of 28 patients. Calvarial thickness was measured on 10 coronal planes, from 3 centimeters (cm) anterior to 6 cm posterior to coronal suture. Fifteen points were measured on each coronal plane, starting in the midline and extending laterally for 7 cm. There were a total of 150 calvarial measurements per patient, covering the surface area used in endoscopic brow lifts. Statistical comparison was performed using analysis of variance. RESULTS: Cranial thickness ranged from 1.1 to 13.6mm, with a mean of 6.1mm. The skull was thickest 2-4 cm posterior to the coronal suture, and thinnest 1cm anterior to the coronal suture. The cranium thins as it extends laterally, with an average thickness of 5.0mm at seven centimeters from midline. Average skull thickness for males was 5.96 versus 6.16 in females. There was no relationship between age and skull thickness. CONCLUSION: Cranial thickness increases medially and posteriorly, and is larger for females compared with their male counterparts. Given the risk of CSF leak, surgeons need to be aware of how cranial thickness varies by location along the skull.

Preoperative and postoperative intracranial complications of acute mastoiditis.

OBJECTIVES: We determined the clinical characteristics and treatment outcomes of an unusual cluster of intracranial complications seen in acute mastoiditis (AM). METHODS: We performed a retrospective review of pediatric patients treated for AM in a tertiary care hospital from March 2006 to March 2007. RESULTS: Eleven children, 6 months to 10 years of age (mean age, 3.8 years), were treated for AM confirmed by computed tomography, which identified asymptomatic intracranial complications in 8 of the 11 patients: these were sigmoid sinus thrombosis (4 patients), epidural abscess (4), perisigmoid abscess or bony erosion (2), and tegmen mastoideum dehiscence (1). All patients required operative intervention with tympanomastoidectomy, although only 2 patients required neurosurgical intervention, consisting of evacuation of epidural abscess and sigmoid sinus thrombosis, respectively. Cultures yielded routine organisms and 1 multidrug-resistant strain of Streptococcus pneumoniae. One patient developed reaccumulation of the subperiosteal abscess that required revision mastoidectomy, and another patient developed postoperative sigmoid sinus thrombosis. CONCLUSIONS: Although uncommon, intracranial complications of AM may present without clinical signs or symptoms. Computed tomography of the temporal bone with contrast is essential for identifying asymptomatic complications. Mastoidectomy remains the mainstay of surgical treatment. Neurosurgical intervention and anticoagulation may be avoided with protracted postoperative intravenous antibiotics. Postoperative vigilance is crucial, as complications may evolve despite aggressive therapy.

Hemangiopericytoma of the larynx.

Hemangiopericytomas are rare vascular neoplasms of the head and neck. Laryngeal involvement is even more rare, with only 9 previously reported cases in the literature. We present an unusual case of a 46 year old with a supraglottic hemangiopericytoma treated surgically. We will review the clinical features and treatment of hemangiopericytomas, as well as a review of the literature. Otolaryngologists need to be aware of this rare tumor that can be treated successfully with surgical resection. Close long-term follow up is needed since recurrence can present many years after initial treatment.

Antidepressants and bleeding risk after face-lift surgery.

OBJECTIVE: To determine the rate of post-face-lift hematoma among users of serotonin reuptake inhibitors (SSRIs) vs non-SSRI users. Selective serotonin reuptake inhibitors have come under recent scrutiny because of possible bleeding risks. However, cessation of SSRIs carries inherent risks. METHODS: The medical charts for 250 consecutive patients who underwent a modified deep-plane face-lift and 13 patients who underwent neck-lift from January 2010 to May 2011 were reviewed for the incidence of postoperative hematoma. Patients' medical records were examined for medical comorbidities, coagulopathy, and medication list, with particular attention to any usage of SSRIs or serotonin norepinephrine reuptake inhibitors (SNRIs). RESULTS: Twenty-two percent of patients were taking SSRIs or SNRIs. We observed a total hematoma (major + minor) rate of 1.95% for non-SSRI/SNRI users vs 1.72% for SSRI/SNRI users. The minor hematoma rate was 1.95% among nonusers vs 0% for users. The major hematoma rate was 0% among nonusers vs 1.72% for users. CONCLUSIONS: Usage of SSRIs was more common in this large series of face-lift patients than in the general population. In these patients, SSRIs in the perioperative period are found to be safe and did not seem to adversely affect outcome. We found no evidence to support discontinuing SSRIs perioperatively.

Case report of a congenital lingual leiomyomatous hamartoma: new epidemiologic findings and a review of the literature.

We present an unusual case of a lingual leiomyomatous hamartoma, along with a current literature review of this previously under reported lesion. Described is a case of a 5 month-old male presenting with a posterior midline tongue mass and surgical excision yielded pathology consistent with a leiomyomatous hamartoma. A comprehensive literature review revealed thirty-nine cases of leiomyomatous hamartomas, a number much greater than previously reported. We conclude that these rare lesions are notably twice as common as previously reported and have equal gender predilection.

Efficacy of the pedicled nasoseptal flap without cerebrospinal fluid (CSF) diversion for repair of skull base defects: incidence of postoperative CSF leaks.

BACKGROUND: The advances in endoscopic skull base surgery have led to the resection of increasingly larger cranial base lesions and the creation of larger skull base defects with the potential for increased postoperative high-flow cerebrospinal fluid (CSF) leaks. These concerns led to the development of the vascularized pedicled nasoseptal flap (PNSF), which is now used as the mainstay for repair of large skull base defects in many academic centers. In this report, we review the incidence of postoperative CSF leaks in our institution in patients undergoing endoscopic skull base repair of high-flow CSF leaks with a vascularized PNSF without concurrent CSF diversion. METHODS: We performed a retrospective analysis at our tertiary care medical center on patients who underwent endoscopic repair of high-flow CSF leaks using a PNSF without CSF diversion between July 2008 and August 2011. Repair materials, incidence of postoperative CSF leaks, and demographic data were collected. RESULTS: Fifty-nine high-flow CSF leaks were repaired with a PNSF and other repair materials, without the use of lumbar catheter drainage. No postoperative CSF leak occurred in this cohort of patients. The overall postoperative CSF leak rate was 0%. CONCLUSION: Meticulous multilayer-closure of skull base defects is critical to prevent postoperative CSF leaks. Although lumbar drainage may be useful in select scenarios, it carries inherent risks of intracranial hypotension and pneumocephalus, and may not be necessary for routine management of high-flow CSF leaks in conjunction with a robust PNSF. Further prospective randomized controlled studies may be warranted to evaluate the efficacy of postoperative lumbar drainage.

Fractional CO(2) laser resurfacing.

Fractionated CO(2) lasers are a new treatment modality for skin resurfacing. These lasers have been shown efficacious in treating facial photoaging changes and scars. These lasers have an improved safety and recovery profile compared with traditional CO(2) laser resurfacing. Precise treatment parameters vary between patients, the pathology treated, and the details of the particular laser.