Management of vocal fold scar with autologous fat implantation: perceptual results.

Vocal fold scar disrupts the mucosal wave and interferes with glottic closure. Treatment involves a multidisciplinary approach that includes voice therapy, medical management, and sometimes surgery. We reviewed the records of the first eight patients who underwent autologous fat implantation for vocal fold scar. Information on the etiology of scar, physical findings, and prior interventions were collected. Videotapes of videostroboscopic findings and perceptual voice ratings [Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS)] were randomized and analyzed independently by four blinded observers. Etiology of scar included mass excision (7), vocal fold stripping (3), congenital sulcus (2), and hemorrhage (1). Prior surgical procedures performed included thyroplasty (1), autologous fat injection (9), excision of scar (2), and lysis of adhesions (2). Strobovideolaryngoscopy: Statistically significant improvement was found in glottic closure, mucosal wave, and stiffness (P = 0.05). Perceptual ratings (GRBAS): Statistically significant improvement was found in all five parameters, including overall Grade, Roughness, Breathiness, Asthenia, and Strain (P = 0.05). Patients appear to have improved vocal fold function and quality of voice after autologous fat implantation in the vocal fold. Autologous fat implantation is an important adjunctive procedure in the management of vocal fold scar, and a useful addition to the armamentarium of the experienced phonomicrosurgeon.

Botulinum toxin in otolaryngology: a review of its actions and opportunities for use.

Botulinum toxin has several important properties that make it an ideal chemical denervator. These include its high degree of specificity for the neuromuscular junction, its ability to induce temporary and reversible denervation, and its limited degree of side effects and complications. Botulinum toxin is being used safely in a wide variety of clinical settings by many different specialists. In otolaryngologic practice, it is being administered for the treatment of at least a dozen conditions, including various dysphonias, dystonias, and spasms as well as torticollis, facial nerve paralysis, and hyperkinetic facial lines. Studies have shown that botulinum toxin injections have a high rate of success in temporarily relieving symptoms.

Maxillary perfusion during Le Fort I osteotomy after ligation of the descending palatine artery.

PURPOSE: Controversy exists regarding management of the descending palatine artery (DPA) during Le Fort I osteotomy. Some surgeons advocate preserving the DPA, and others ligate the vessels. The purpose of this study was to evaluate maxillary gingival blood flow (GBF) during Le Fort I osteotomy in a sample of patients with and without ligation of the DPA. PATIENTS AND METHODS: Using a prospective randomized clinical study, we enrolled a study sample composed of 34 patients undergoing Le Fort I osteotomy. The patients were randomly assigned to either study group 1 (16) (DPA ligated) or group 2 (18) (DPA preserved). To measure maxillary GBF during the operation, we used laser Doppler flowmetry (LDF). The predictor variable was status of DPA management (ligated or preserved). The outcome variable was change in GBF over time. RESULTS: (DPA). Before ligation (or simulated ligation) of the DPA, the mean GBF for groups 1 and 2 was 11.4 +/- 8.6 and 11.9 +/- 9.4 mL/min/100 g tissue, respectively (P = .88). After ligation of the DPA in group 1, the mean GBF was 10.0 +/- 7.7 mL/min/100 g tissue. At the corresponding time in group 2 (DPA preserved), the mean GBF was 12.6 +/- 9.4 mL/min/100 g tissue. The difference in mean GBF between groups 1 and 2 was not statistically significant (P = .43). CONCLUSION: There were no statistically significant differences in mean maxillary GBF between patients having the DPA ligated and those having the DPA preserved as measured using LDF during Le Fort I osteotomy.

The effect of local anesthesia with vasoconstrictor on gingival blood flow during Le Fort I osteotomy.

PURPOSE: In earlier studies, it has been documented that maxillary gingival blood flow (GBF) decreased significantly during the intraoperative course of a Le Fort I osteotomy. It was not clear, however, whether the observed decrease in GBF was caused by the osteotomy or by the use of local anesthetic with vasoconstrictor (LA + V). The purpose of this study was to measure the effect of LA + V on GBF during Le Fort I osteotomy using laser Doppler flowmetry (LDF). PATIENTS AND METHODS: Using a randomized clinical trial study design, patients undergoing Le Fort I osteotomy were assigned to either a treatment (group 1, LA + V used) or a control group (group 2, LA + V not used). The predictor variable was group assignment (LV + V used or not used). The outcome variable was mean maxillary GBF. Maxillary GBF was recorded at predetermined times during the operation. Other study variables included age, sex, single- or double-jaw surgery, estimated blood loss, direction and magnitude of maxillary movements, temperature, pulse, mean blood pressure, O2 saturation, and duration of operation. RESULTS: There were 19 patients in group 1 (LA + V used) and 15 patients in group 2 (LA + V not used). In both groups, mean maxillary GBF decreased significantly during the operation (group 1, 33.3 +/- 13.1 to 16.9 +/- 16.1 mL/ min/100 g tissue, P = .015; and group 2, 48.2 +/- 17.1 to 15.5 +/- 7.6 mL/min/100 g tissue, P = .001). The decrease in GBF occurred much earlier in group 1. By an average of 2.3 hours into the operation, the mean GBF was equivalent in both study groups (group 1, 10.6 +/- 8.6, and group 2, 13.1 +/- 9.4 mL/min/100 g tissue, P = .44). CONCLUSIONS: The results of this study confirm earlier findings that mean maxillary GBF decreases significantly during the intraoperative course of a Le Fort I osteotomy. In addition, LA + V significantly affects GBF during the early phase of the operation. Its effect, however, dissipates between the time of soft tissue dissection and maxillary downfracture.

Are head, neck and facial injuries markers of domestic violence?

Few data exist regarding the relationship between the location of injuries and the presence of domestic violence. This study of 127 people at an inner-city hospital emergency department found that most patients had head, neck and facial injuries. Although only 23 percent of patients with such injuries were victims of domestic violence, 94.4 percent of victims of domestic violence had head, neck and facial injuries. The study results indicate that head, neck and facial injuries could be markers of domestic violence.

Intraoperative assessment of maxillary perfusion during Le Fort I osteotomy.

Intraoperative maxillary blood flow was measured using laser Doppler flowmetry (LDF) in two groups of patients undergoing orthognathic surgery. Group 1 (n = 14) consisted of patients undergoing Le Fort I osteotomy and group 2 (n = 8) consisted of patients undergoing isolated mandibular osteotomies. In group 1, the mean gingival blood flow (GBF) decreased significantly over time during the course of the operation from 29.5 mL/min/100 g of tissue to 13.2 mL/min/100 g of tissue (P = .0001). The mean GBF did not change significantly over time in group 2 (P = .39). The results of this study demonstrate that 1) LDF may be used to measure intraoperative GBF during Le Fort I osteotomy with an acceptable level of variability, and 2) maxillary GBF decreased significantly over time during Le Fort I osteotomy procedures.