Is outpatient suction cautery tonsillectomy safe in a community hospital setting?

Tonsillectomy and adenotonsillectomy are frequently performed operations. They are typically done as a day-of-surgery admission with discharge on the first postoperative day. Five hundred consecutive tonsillectomies and adenotonsillectomies performed by the authors were retrospectively reviewed to determine if these procedures could safely be performed on an outpatient basis. Primary postoperative hemorrhage was found to be rare using the suction cautery technique. Secondary hemorrhage occurred most commonly on the sixth postoperative day and the overall postoperative bleed rate was 7%. Our conclusion was that suction cautery tonsillectomy and adenotonsillectomy were safe to perform on an outpatient basis.

Modification of horizontal jaws of alligator forceps.

Modification of horizontal opening alligator forceps has been developed. In my experience, this instrument has made certain maneuvers in otologic surgery easier.

The Haberman suction elevator.

A suction elevator for nasal surgery has been developed. Surgical trial has demonstrated effectiveness and I recommend consideration of its use.

Angle-tipped Baron suction tubes.

Modified Baron no. 3 suctions angled at the tips have been found to be valuable during otologic surgery. The 3-mm length has been found most helpful and its use is recommended.

Laryngeal adenocarcinoma, not otherwise specified, treated with carbon dioxide laser excision and postoperative radiotherapy.

Glandular carcinomas of the larynx are aggressive neoplasms that comprise less than 1% of all laryngeal malignancies. Adenocarcinoma, not otherwise specified, is the most common histologic type. The rarity of these lesions has prohibited clarification of definitive therapy. Traditionally, radical surgery is performed because of the usually high stage at presentation and the relative insensitivity to radiotherapy. A case of glottic T1 adenocarcinoma, not otherwise specified, is reported. The tumor presented clinically as a vocal fold granuloma. The treatment modalities included endoscopic excision with the carbon dioxide laser and postoperative radiotherapy. The patient has been followed up for 39 months without evidence of recurrence or metastases. The current literature is reviewed in regard to treatment of laryngeal glandular carcinomas.

Recurrent acquired atresia of the external auditory canal and associated canal cholesteatoma.

Acquired atresia of the external auditory canal associated with medial canal cholesteatoma is a rare finding. Recurrence of this pathologic picture redevelops three times. Various speculations regarding possible etiologic factors, as well as audiometry and treatment are discussed.

False-positive MRI and CT findings of an acoustic neuroma.

CT and MRI are excellent imaging modalities available in the work-up of a patient with suspected acoustic neuroma. A case is presented where both CT and MRI suggested the presence of a small acoustic neuroma. Exploration of the cerebellopontine angle and internal auditory canal revealed no evidence of a tumor. A vascular loop around the inferior and superior vestibular nerves was identified and decompression completely eliminated the symptoms. Even with today's sophisticated diagnosis tools available to evaluate a suspected acoustic neuroma, the definitive diagnosis and subsequent treatment may change at surgery.

Candida epiglottitis.

Acute epiglottitis is most commonly of bacterial origin. A case of Candida epiglottis in a healthy, nondebilitated patient is reported. A literature search did not produce a previously reported case.