Endoscopically guided CO2 laser turbinectomy

P124

OtolaryngologyHead and Neck Surgery August 1999

Scientific Sessions--Monday

Cranial neuropathies constitute the most significam clinical problem of patients with jugular forarnen tumors. Conclusion: With meticulous surgical techniques and intraoperative monitoring, functional recovery can be expected in a large proportion of patients. When permanent dysfunction is expected, rehabilitative intervention must occur prior to onset of life-threatening complications.

9:54 AM Implant Stability Using Resonance Frequency Analyses ANDERS R M TJELLSTROM MD PHD (presenter); GOSTA GRANSTROM MD DDS PHD; Goteborg Sweden

Objectives: Osseointegrated titanium implants are today widely used in otolaryngology for retention of implantable bone conductors, BAHA, and craniofacial prostheses. A new technique to measure the stability of implants at the time of surgery and later on without disturbing the bone-to-implant interface has been developed and will be presented. Method." An L-shaped transducer made of 2 piezoelectric elements is attached to the fixture during surgery and/or to the abutment/BAHA coupling at the out patient clinic during follow-up. The transducer is vibrated at 5 to 15 kHz through one of the piezoelectric elements. The other element analyzes the response. The amplitude is plotted against the frequency using a PC, and the first resonance frequency is identified. The resonance frequency is determined by the stiffness at the implant-bone interface. Results: Clinically stable implants in the mastoid process showed sharp, well-defined peaks around 8 kHz. Lower values and less sharp peaks were seen in implants in poor-quality bone like the irradiated midface. In these cases the resonance peak was also shifted toward the lower frequencies. The time it takes to make one measurement is less than 1 minute. Conclusion: The described technique is a noninvasive way to evaluate implant stability at a specific time. It will be of great value in the decision when an implant could be loaded and also provide the anaplastologist with information of the loading capacity of each implant used for a facial epitheses. It will be possible to follow implant stability over time.

well as full acoustic rhinometric evaluation before and 12 months after surgery. Results: Subjective impression of improved nasal airway was achieved in 91% (EGLT) and 76% (RFF). Acoustic rhinometric data (minimal cross-sectional area and mean decongestive effect) demonstrated improved nasal patency in 89% (EGLT) and 61% (RFT). The differences were statistically significant. Conclusion: Endoscopically guided laser turbinectomy allowed more thorough reduction of the turbinate, and its results were far superior to those of radiofrequency turbinectomy. ] 0 ; ] 0 AM

Microvascular Free Flaps in Head and NecR Reconstruction: A Retrospective Review RAJIV T PANDIT MD (presenter); GUY J PETRUZZELLIMD PHD; Oak Park IIs Maywood IL

Objectives: Microvascular free flap reconstruction of the head and neck is being increasingly utilized for its numerous advantages. However, this is a technically challenging, laborintensive procedure that requires additional operative equipment and usually 2 surgical teams. This study evaluates the institutional success rate of this procedure and correlates this success rate with the patient's preoperative status. Methods: Fifty-four consecutive patients who underwent free flap reconstruction of the head and neck were included. All patients underwent reconstruction by the same surgeon. Results: The overall success rate was 92%. Patients with no previous treatment had a higher success rate, while success rates of patients with significant medical comorbidities were notably lower. Patient age did not correlate with flap outcome. Conclusion: Despite their complexity, microvascular free flaps in head and neck reconstruction are successful procedures that should be increasingly utilized in large head and neck defects. Advanced age should not be used to exclude patients who may otherwise benefit from this procedure.

9:30 to 10:18 AM MCC Room 273

Endoscopically Guided CO z Laser Turbinectomy

Contributed Papers: Head and Neck Surgery

SAMY S ELWANY MD (presenter); HOSSAM THABET MD; Alexandria Egypt; Alkhobar Saudi Arabia

CHARLES M STIERNBERG MD; LINDA GAGEWHITE MD ( m o d e r a t o r s )

10:02 AM

Objectives: The study describes and evaluates a new technique for endoscopically guided laser inferior turbinectomy (EGLT) using the Flexilase nasal fibers, and compares its results against those with radiofrequency turbinectomy (RFI') using subjective and objective criteria. Methods: One hundred forty-eight patients who were candidates for inferior turbinectomy were randomized into 2 groups. All patients underwent formal rhinologic examination aud were given a specially designed patient questionnaire as

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9:30 AM

Thyroidectomy Neural Monitoring: Cordal and Postcrlcoid Electrodes GREGORYW RANDOLPH MD (presenter); Boston MA

Objectives: Recurrent laryngeal nerve (RLN) monitoring during thyroidectomy can aid in nerve identification, avoidance of nerve injury and prediction of postoperative function. We compared 2 convenient available electrode arrays. Method: Passive and evoked EMG recordings were ana-