Translacrimal transnasal laser-assisted dacryocystorhinostomy.

Chronic dacryocystitis is due to an obstruction in the nasolacrimal duct, with subsequent infection of the lacrimal sac. The goal of surgery is to reestablish intranasal drainage of the lacrimal sac. Classic dacryocystorhinostomy (DCR) requires an external incision and drilling through the lacrimal bone into the middle meatus. In our study a 600-micron neodymium:YAG (Nd:YAG) fiber with a blunt hemispherical tip is inserted via the lacrimal puncta. An intranasal ostium is created with the laser under intranasal endoscopic control. Silicon tubes are then left in place for 6 months. We have performed 49 procedures over the past 2 1/2 years, with a success rate of 85% after one surgical procedure, which is commensurate with standard DCR. This procedure provides a simple, bloodless, incisionless alternative to standard DCR.

Laser-assisted uvula-palatoplasty for snoring.

Laser-assisted uvula-palatoplasty (LAUP) is a new and effective surgical method for the elimination of habitual snoring. LAUP is safely performed under local anesthesia in the office, and it provides progressive enlargement of the oropharyngeal air space by reshaping and restructuring the uvula, soft palate, and pharyngeal pillars utilizing the CO2 laser with special attachments. LAUP can also reduce oropharyngeal obstruction that may occur during sleep in patients with obstructive sleep apnea syndrome. Our experience includes over 335 patients evaluated and treated within the past year. Successive laser ablation of the vibrating structures, such as the uvula, soft palate, and posterior pharyngeal pillars, provided an 84% cure rate. In addition, 7% of the patients reported significant improvement in the loudness of their snore. The major advantage of this surgical technique is that it is a safe, simple, reliable, and bloodless procedure that can be performed in the office. This method and the results of its use are discussed.

The effects of lower lateral cartilage excision on nasal tip projection.

Nasal tip projection is an important defining feature of the nasal profile. Loss of projection is often the bane of the rhinoplastic surgeon. While augmentation techniques for maintaining or increasing tip projection are useful in selected patients, the majority of rhinoplasties rely on excision of cartilage, particularly cartilage of the cephalic border of the lower lateral crura, to produce the desired cosmetic result. The purpose of this study was to measure the effects of lower lateral cartilage excision on nasal tip projection resulting from three common forms of nasal tip surgery. These techniques included cephalic border resection without vertical dome division, cephalic border resection with vertical dome division, and cephalic border resection with dome division and suture reapproximation of the mesial crura, the so-called "Goldman tip." Despite the fact that overall excellent results were obtained and loss of projection was rarely a noticeable feature, a measurable loss of projection can be seen in all but one case in this series. Although loss of tip projection is usually acceptable due to the masking effect, the concurrent reduction in dorsal nasal height, loss of projection must be anticipated in excisional techniques of the lower lateral cartilage.

Isolated sphenoid sinus disease.

Forty-three cases of isolated sphenoid sinus disease were reviewed. In 33 cases, headache was a presenting symptom. Seven of 29 cases of inflammatory disease and nine of 13 patients with tumors of the sinus presented with cranial nerve findings. When nonspecific visual disturbances were eliminated, two of 29 cases of inflammation and eight of 13 cases of tumors of the sphenoid sinus had cranial nerve deficits. Ten of 12 CT scans performed on patients with tumors of the sinus demonstrated bony erosion or perisinus extensions. This was not found in any of the 27 scans of patients with inflammatory disease. A thorough cranial nerve examination and a CT scan should be performed early in patients who present with vague and unusual headaches.