Treatment of ectopic intratracheal thyroid with a holmium laser.

The report describes an 85-year-old woman who underwent ectopic intratracheal thyroid ablation with a holmium laser. This represents a novel use of a holmium laser and a potential alternative for commonly performed open intratracheal thyroid excisions.

Planned neck dissection following primary chemoradiation for advanced-stage head and neck cancer.

OBJECTIVES: To determine the prevalence of residual cancer in planned neck dissection specimens for advanced-stage squamous cell carcinoma following chemoradiation. STUDY DESIGN: A case series. SETTING: A single-surgeon community-based head and neck practice. SUBJECTS AND METHODS: Twenty-six patients were identified during 2000 to 2007. All patients were treated with external beam radiation; the average dose to the neck was 60 Gy (range 50-72 Gy). Concurrent chemotherapy was given with cisplatin and 5-fluorouracil. Patients presenting with greater than N2 cervical disease and at least one node greater than 3 cm were considered advanced. Post-chemoradiation physical examinations were performed by the primary surgeon and oncologist. Absence of physical evidence of disease was deemed a complete clinical response. RESULTS: Fourteen of 21 (67%; 95% confidence interval [CI], 0.449-0.854) patients were found to have carcinoma in their neck specimens. Seven patients were noted to have a clinically complete response, and two of seven (29%; 95% CI, 0.053-0.659) patients with a clinically complete response were found to have carcinoma in their neck specimens. Fourteen patients were noted to have an incomplete response to therapy. Two of these 14 (14%; 95% CI, 0.026-0.419) patients had negative pathology in their neck dissection specimens. Three patients had local recurrence and succumbed to their disease. CONCLUSION: Planned neck dissection in the setting of advanced neck disease following chemoradiation should remain an important consideration when counseling patients presenting with advanced cervical metastasis from squamous cell head and neck cancer.

Comparison of closed reduction alone versus primary open repair of acute nasoseptal fractures.

OBJECTIVE: Nasoseptal injuries have traditionally been treated via closed reduction. Historically, the high incidence of postreduction deformities has led some surgeons to consider alternative approaches to obtain superior results. Here we compare simple closed reduction versus primary open repair of the nasoseptal fracture. STUDY DESIGN: This was a prospective study of 40 consecutive patients treated with simple closed reduction of their combined nasal bone and septal fracture versus 40 patients treated with closed reduction of their nasal bone fracture and open treatment of the septum. Group outcomes were then compared. RESULTS: In the closed reduction group, 60% had significant postoperative septal deviation, whereas only 12.5% suffered from residual septal deformity in the open group. This resulted in a statistically significant reduction (p < .01) of patients requiring a second operation to formally address the septum. CONCLUSION: By addressing the septum through an open approach, a statistically significant reduction in the number of patients requiring revision rhinoplasty was achieved.

Aneurysmal bone cyst of the temporal bone associated with reversible hemifacial paralysis.

Aneurysmal bone cyst (ABC) is an uncommon lesion of the temporal bone (TB), with only 20 cases reported. Facial paralysis is a rare complication (2 cases); however, no cases have been reported with preoperative reversal of paralysis. We report a 60-year-old man with a history of remote head trauma, who presented with serious otitis media and right hemifacial paralysis, which resolved with nonsurgical therapeutic measures. Magnetic resonance imaging and computed tomography showed a destructive and expansile lesion of the TB. The lesion was surgically removed, and ABC was diagnosed histologically. The patient had an uneventful recovery and demonstrated no recurrence at 1 year of follow-up. This report presents an unusual presentation of ABC in the TB, with a review of the clinical, radiological, pathological, and therapeutic features of this entity.