Repair of the Malpositioned Lower Lid

Complications from surgical approaches to the orbit can be associated with debilitating morbidity and negative surgical outcomes. The surgeon must be familiar with the different factors that predispose a patient to these complications and be facile with techniques to avoid them. In this article, the authors discuss the surgical anatomy of the lower eyelid, as well as various complications that result from eyelid surgery, including lower lid retraction, ectropion, entropion, canthal malposition, and midface descent. They also discuss various management techniques that are employed in addressing these complications

Management of Rare Thyroid Malignancies

The purpose of this chapter is a focused analysis and review of rare thyroid malignancies including anaplastic thyroid cancer (ATC), medullary thyroid cancer (MTC), primary thyroid lymphoma (PTL), and primary thyroid sarcoma (PTS). The focus will be on the epidemiology, risk factors, workup, and a contemporary review of management of these rare entities

Scar Revision: Surgical and Nonsurgical Options

Facial scarring represents a challenging issue for the facial plastic surgeon owing to the unpredictable and variable nature of scar formation. The psychologic, cosmetic, and functional implications of facial scars oftentimes necessitate revision. It is important for the facial plastic surgeon to be aware of the invasive and noninvasive options to best educate patients in terms of treatment modalities. As there are multiple options available with no single option touted as superior, management of expectations and patient motivation will allow for realistic treatment planning with the greatest change of success

Management of Enophthalmos from Silent Sinus Syndrome with a Customized Orbital Implant

Background We describe the surgical treatment of silent sinus syndrome, a disease characterized by progressive enophthalmos and hypoglobus due to orbital floor collapse with opacification of the maxillary sinus, in the presence of chronic maxillary sinusitis. Methods Case study of a 55-year-old male with persistent diplopia secondary to left-sided esotropia and enophthalmos from chronic maxillary sinusitis. Results Two stage procedure to treat the sinonasal and orbital symptoms, which include endoscopic sinus surgery to treat the underlying the ostial obstruction along with decompression of maxillary sinus. Then, reconstruction of the orbital floor with a customized implant. Conclusions Though the treatment of silent sinus syndrome can be challenging, we demonstrate the successful use of a customized orbital implant in the treatment of diplopia and enophthalmos from silent sinus syndrome using a two-stage approach

Orbital Skull Base Reconstruction with Temporalis Muscle: The Sphenoid Keyhole Technique

The temporalis flap is a common flap used in head and neck reconstruction. In this article, the authors present a new modification of the use of the temporalis muscle flap for orbital skull base reconstruction with the use of a sphenoid keyhole. This technique confers multiple advantages in reducing the arc of rotation and providing a tension-free reconstruction of the orbital skull base

Holmium Laser for Endoscopic Treatment of Benign Tracheal Stenosis

Introduction Laryngotracheal stenosis is a difficult problem with varied etiology and various treatment options. The holmium laser represents another tool for the treatment of benign tracheal stenosis. Objectives To determine the utility of holmium laser treatment for benign tracheal stenosis with regards to safety and efficacy. Methods This was a retrospective case study examining patients with benign tracheal stenosis from 1998–2016 who underwent holmium laser treatment. Determining the safety of this procedure was the primary goal, and complications were monitored as a surrogate of safety. Results A total of 123 patients who underwent holmium laser treatment for benign tracheal stenosis were identified. In total, 123 patients underwent 476 procedures, with follow-up ranging from 1 month to 14 years. No intraoperative or post-operative complications were identified as a direct result of the use of this particular laser. Conclusions The holmium laser is an effective and safe laser to use for tracheal stenosis treatment. It is a contact laser with a short acting distance, which reduces the risk of injury to distal airway structures. Given the favorable experience reported here, the holmium laser should be considered when tracheal surgery is attempted

TORS excision of lingual thyroid carcinoma: Technique and systematic review

OBJECTIVE: Clinically significant lingual thyroid tissue has a prevalence of 1/3000-10,000, and in 70% of these individuals, the lingual thyroid is their only thyroid tissue. Malignant transformation is exceedingly rare. Herein, we present a case of lingual thyroid carcinoma with a systematic literature review and description of our treatment technique. DATA SOURCES: PubMed, Ovid. REVIEW METHOD: The primary author performed a search of the literature for reports of lingual thyroid carcinoma or ectopic thyroid carcinoma associated with the tongue. Articles that did not present novel data, presented cases of ectopic thyroid carcinoma outside the tongue, non-malignant cases, non-thyroid carcinomas, or were non-English articles were excluded. Studies were limited to those published in the last 60 years. RESULTS: There are 39 cases reported in the literature. 23 cases occurred in females. Age at diagnosis ranged from 12 to 86; cases were more commonly diagnosed in the second decade of life, then in the 5th and 6th decades of life. Dysphagia, globus sensation, episodes of bleeding, voice changes, and presence of a neck mass were common symptoms at initial presentation. Nearly all patients underwent some form of pre-operative imaging, but practices varied as to the type of imaging. Treatment included surgical excision of the tumor in all but one case that was successfully treated with radioactive iodine therapy alone. CONCLUSIONS: Surgeons should be aware of lingual thyroid, its presentation, workup, and carcinoma treatment. Tumors are amenable to surgical excision, possibly followed by radioactive iodine therapy. Advances in robotic and endoscopic surgery over the past decade now allow for less morbid excisions of lingual thyroid tumors