Unusual Axillary Artery Branching Pattern Associated with Multiple Neural Variations.

OBJECTIVE: This report presents a unilateral branching pattern of the axillary artery (AA) represented by an unusual common trunk division, vessel multiplications and concomitant neural variations. CASE REPORT: In a Greek male cadaver, the right AA branched into a subscapular trunk and two accessory lateral thoracic arteries of variable origin and course. Concomitantly, a high-level interconnection between the musculocutaneous and median nerves was identified, as an accessory lateral root of the median nerve. More interestingly, a rare innervation of the upper part of the latissimus dorsi muscle by a lower subscapular nerve was also revealed. CONCLUSION: In-depth knowledge of the typical and variant AA branching patterns and coexisting neural variations is of paramount importance for surgeons and interventional physicians, for a safer diagnosis and for performing uneventful procedures in that area.

A Large Laryngeal Mucocele Causing Progressive upper Airway Obstruction and Cervical Swelling.

Laryngocele (LC) is an uncommon clinical entity, occasionally associated with fatal complications. If its neck becomes obstructed, mucous accumulates and then a laryngeal mucocele (LMC) is formed. Reports of LMCs are rare in the literature. A fluid-filled combined LMC in a 48 year-old Greek construction worker with presenting symptoms of cervical swelling and dysphonia is described. The male patient was surgically treated via an external approach. A LC rarely becomes symptomatic and infection unusually occurs. Magnetic resonance imaging depicts in detail the size, extension and structure of the neck mass and remains the diagnostic gold standard, providing superior soft-tissue discrimination, in cases of a concurrent laryngeal tumor. Histopathological examination confirms diagnosis, since there is always a high index of suspicion for malignancy. Established guidelines regarding surgical treatment of a LC do not exist. Although during the last two decades micro laryngoscopy with CO2 laser has gained popularity for the treatment of an internal LC, the external approach still remains the method of choice in cases of a combined LMC.

Surgical and anesthetic considerations of laryngeal saccular cyst: a case report.

INTRODUCTION: Supraglottic laryngeal cysts are benign, uncommon lesions that have the potential to cause airway compromise. CASE PRESENTATION: We present a case of a 46-year-old Caucasian woman who was scheduled for excision of a large neck growth (saccular cyst) and was managed successfully. There was thorough consideration regarding anesthetic and surgical management. Steps taken led to a successful excision with no recurrence during follow up. CONCLUSION: This case was an opportunity to consider the challenges in the airway management associated with such cysts and provided reassurance that excision of these cysts is associated with a good post-operative outcome.

Use of Glasgow Benefit Inventory (GBI) in Meniere's disease managed with intratympanic dexamethasone perfusion: Quality of life assessment.

OBJECTIVE: To evaluate patients' quality of life following intratympanic dexamethasone perfusion in management of Meniere's disease (MD). METHODS: This is a retrospective study in a tertiary referral center that uses the Glasgow Benefit Inventory (GBI). Intratympanic perfusion of 24mg/ml of dexamethasone was administered after failure to respond to previous management with diuretics and low-salt diet. GBI questionnaires were collected and analyzed in a 12 months follow-up of participating patients. RESULTS: Thirty patients (20 women and 10 men, aged 28-85 years) with MD underwent intratympanic dexamethasone perfusion and were assessed with the assistance of GBI questionnaire. Follow-up ranged from 12 to 48 months (mean 30 months). Audiometric results were also available in all of them. In the short term (4 weeks post-perfusion) 6 patients demonstrated a greater than 10dB improvement in PTA, and 6 patients had an increase in SDS of at least 15%, while in the long-term (12 months post-perfusion) the number of patients in the respective groups decreased to 5 and 2. With regards to the GBI responses, 9 patients (50%) expressed an overall benefit, while 6 (33%) expressed no benefit and 3 patients (17%) complained of negative effect after the intervention. CONCLUSION: The mean GBI score indicates substantial improvement in patients' overall quality of life following intratympanic dexamethasone perfusion, which was also confirmed by the audiometric results.

Cartilage shield tympanoplasty: a reliable technique.

OBJECTIVE: Cartilage shield tympanoplasty is a procedure for repairing total tympanic membrane perforations. This procedure is indicated primarily for patients with total perforations, severely atelectatic tympanic membranes, and failures of previous tympanoplasty associated with chronic eustachian tube dysfunction. Although the graft take of this technique has been reported to be excellent, there have been concerns regarding hearing results because it replaces the entire tympanic membrane with cartilage. The purpose of this study was to report our experience with this technique. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary care hospital: Virginia Commonwealth University Medical Center, Richmond, Virginia, USA. PATIENTS: Between 1998 and 2003, 62 patients were identified who had a cartilage shield tympanoplasty. The patients' ages ranged from 7 to 72 years (mean, 32 years). INTERVENTION: Therapeutic. MAIN OUTCOME MEASURES: Graft take was evaluated in all patients and postoperative complications were noted. In 58 patients, pre- and postoperative audiograms were available and pure-tone average air-bone gaps were compared using the Student's t test. RESULTS: Graft take was accomplished in 61 patients (98.4%) and there were no postoperative complications. The average preoperative and postoperative pure-tone average air-bone gap was 32.4 +/- 14.1 dB and 24 +/- 13.7 dB, respectively (p < 0.005). CONCLUSION: This study reveals that cartilage shield tympanoplasty has a high degree of graft take, and hearing results are satisfactory.