The Le Fort I osteotomy approach for nasopharyngeal and nasal fossa tumors.

The nasopharynx, pterygopalatine fossa, and nasal fossa are difficult areas in which to gain wide surgical access. The transverse maxillary osteotomy with downfracturing of the entire palate and inferior maxilla has recently been adopted as a surgical option. Simultaneous bilateral wide surgical exposure is achieved in the maxillary, ethmoidal, and sphenoidal sinuses, nasal fossa, clivus, pterygopalatine fossa, and medial portion of the infratemporal fossa. Compared with other popular techniques, the transverse maxillary osteotomy provides excellent exposure for angiofibromas, clivus tumors, and other tumors of the central base of the skull and midface regions. The details of the procedure and relevant physiology of the osteotomized segment are presented. The safe attainment of wide surgical exposure will be demonstrated. This procedure has worldwide acceptance for orthognathic surgery and is easily adapted to head and neck oncologic surgery.

Laryngeal dysgenesis.

A case of a previously undescribed anomaly of the larynx is presented and offers insight and support of current concepts of fetal laryngeal development. The patient possessed unilateral absence of true and false vocal cords, laryngeal ventricle, and saccule. Current concepts of embryological development would place the development of this anomaly and most of the patient's other multiple anomalies in the period of the 6th to 9th weeks of fetal life. This report lends substantiation to the stages of laryngeal development by demonstrating an aberration in the normal sequential development. Additionally, the time period of this maldevelopment is suggested by the concurrence of multiple other anomalies. Aspects of laryngeal embryology relevant to laryngeal maldevelopment are reviewed.

An approach to large nasoseptal perforations and attendant deformity.

Six patients with symptomatic large anterior septal perforations were treated for relief of symptoms and the frequently concomitant saddle-nose deformity. The patients required large anteriorly and posteriorly based rotation flaps consisting of mucoperiosteum from the floor, lateral wall, and inferior turbinate of the nose.

Congenital laryngeal stridor (laryngomalacia): etiologic factors and associated disorders.

Congenital laryngeal stridor (CLS) and laryngomalacia are terms used to describe a common disorder characterized by onset, at or soon after birth, of a harsh respiratory sound mostly audible during inspiration. Typically, laryngoscopy reveals flaccid supraglottic structures which tend to prolapse medially toward the glottis during inspiration. Despite reports of this disorder dating back to the mid-19th century, specific etiology and pathogenesis remain nebulous. Analysis of findings in 30 infants indicate that there are often associated manifestations of delayed development in neuromuscular control. Associated findings include gastroesophageal reflux, obstructive and central apnea, hypotonia, failure to thrive, and pneumonitis. A retrospective review of relevant medical literature along with results of laryngeal dissections and analysis of clinical findings in the 30 cases leads to the conclusion that CLS may be a mild form of localized hypotonia rather than an isolated idiopathic type of anatomic abnormality.