Functional endoscopic sinus surgery

The theory behind functional endoscopic sinus surgery (FESS) is to re-establish drainage from the maxillary, ethmoid, sphenoid, and frontal sinuses. In addition, allowing the ostiomeatal complex to stay patent is an important factor in re-establishing mucociliary clearance from the dependant sinuses. By achieving adequate drainage from the natural ostium, the mucosal disease and subsequent symptoms could become reversible in many cases. Many children who are considered for FESS have comorbidities that include allergies, immune deficiency, ciliary disorders or cystic fibrosis. Medical management should be maximized before FESS. There are multiple methods and techniques described to perform FESS; however, in this manuscript we will describe an anterior to posterior technique used at the University of Miami

Endoscopic embolization and resection of juvenile nasopharyngeal angiofibromas

Juvenile nasopharyngeal angiofibromas (JNAs) are rare tumors found exclusively in adolescent boys. Over the last 10 years, endoscopic approaches for resection of JNAs have been used, yielding acceptable results and relatively low recurrence rates. Endoscopic resection preceded by embolization has been shown to be superior to open approaches from a blood loss and hospital stay standpoint. We have performed the first direct intratumoral embolization using the new liquid embolic substance Onyx in cooperation with neurosurgery through endoscopic visualization of the tumor. This article describes our technique for embolization and endoscopic resection of JNAs

Endoscopic embolization with onyx prior to resection of JNA: A new approach

To report a novel pioneering approach of endoscopic embolization (EE) and resection of juvenile nasopharyngeal angiofibroma (JNA) and describe all outcomes and results. Four patients presented to the University of Miami with repeated episodes of unilateral epistaxis diagnosed by fiberoptic and radiographic examination as nasal JNA. Subsequently, in conjunction with neurosurgery, endoscopic visualization was provided to perform intratumor needle insertion, through which the liquid embolic agent Onyx was infused to embolize the JNA's under fluoroscopic and endoscopic guidance. The day after EE, endoscopic resection was performed. Operating room time, estimated blood loss (EBL), and other intraoperative and post-operative results are reported and compared to published literature. A total of 4 patients (all males), had EE of JNA and subsequent endoscopic resection between September 2008 and January 2009. Average EBL during surgery was 412.5 ml (range 150–800) with an average operating room time of 228 min (range 95–485). We experienced no bleeding from the tumor or its attachments, only from the approach. Two patients experienced mild numbness in the V2 distribution, which began to resolve one week post-operatively. No other complications were encountered. This is the first published report of direct endoscopic embolization of JNA with Onyx. Although further studies are needed, it seems to provide a safe, less invasive alternative to traditional embolization and endoscopic resection, but must be done in cooperation with interventional neurosurgery to maximize its safety profile

S191 – Unilateral Vocal Fold Paralysis: Medialization Results

Objectives Management of glottal insufficiency due to unilateral vocal fold paralysis (UVFP) has evolved from trans-oral injection to external thyroplasty to revisited injections (transoral or transcutaneous). Currently, preference is given to the less invasive injection medialization. Multiple injectable materials have been utilized with newer ones being introduced to manage concerns over permanency and vocal fold vibratory patterns. The purpose of this study is to evaluate the long-term results of injection medialization for UVFP in terms of stability of glottal closure and voice outcome vs. need for reinjection. Methods All patients with UVFP that underwent injection medialization and had follow-up studies more than 6 months were eligible for inclusion. Parameters studied included demographic data (age, gender), side of paralysis, etiology, degree of pre-injection glottal insufficiency, length of follow-up, degree of post-injection glottal closure, mucosal wave resolution, and Voice Handicap Index. Results 146 patients were identified with a mean age of 61.7 years (17–94); males (55%) and females (45%). Etiology was idiopathic (56%); iatrogenic (48%); tumor-related (9%); trauma (3%); and neurologic (2%). Degree of glottal insufficiency was mild (21%); moderate (29%); and severe (50%). Material injected was Cymetra in 80 patients and Radiesse in 66 patients. 45 (33%) patients underwent more than 1 injection. Details of patients requiring repeat injections with regards to the material injected and the other parameters will be presented. Conclusions Injection medialization via a transcutaneous approach has long-lasting results making it an appropriate minimally-invasive option for long-term medialization for UVFP

Mechanisms of chemotherapeutic-induced hearing loss and otoprotection

Cisplatin (CDDP) and carboplatin are highly effective chemotherapeutic agents with ototoxic side effects that limit their efficacy. Formation of reactive oxygen species (ROS) in CDDP-exposed cochlear tissues is involved in ototoxic action of the CDDP on hair cells. Downstream targets of ROS are cell death mediator molecules, for example, p53 and activated caspases. The efficacy of several otoprotective compounds is discussed in relationship to their impact on protection of hearing and potential for interfering with the chemotherapeutic treatment of cancer. Richard Smith – University of Iowa, Iowa City, US