Miscellaneous Facts for ENT

·         "CARDIOSPASM / ACHALASIA CARDIA---difficulity for swallowing Liquids but not for solids, ass.with DEGENERATION of nerve plexus in the oesophagus, Barium Swallow-shows-Dilatation with smooth narrow ending, "--------((3))

·         "FRACTURES OF ZYGOMA--- undisplaced fracture--no specific Rx

·         An easy way to remember the behavioral complications of OSA: APRIL

Aggression

Poor school performance

Restlessness

Irritability/hyperactivity

Lack of attention

• Teratomas are composed of all three germ layers, consist of tissue that is foreign to their site, and are larger than dermoid cysts. Dermoid cysts are composed of ectoderm and mesoderm, arising from entrapped epithelium, and tend to occur along the lines of embryonic fusion (midline). Dermoid cysts characteristically have an adipose matrix that appears "cheesy." Both are anomalies involving pluripotential embryonal cells and are managed by complete surgical excision.

• Traditionally, the mandibular series has included several views of the mandible to view the entire mandible adequately. These have included anteroposterior and bilateral oblique views to assess the symphysis, parasymphysis, body, angle, and ramus. Special views (Towne's projection) are often required to assess the medial or lateral displacement of the condyle. Currently, the panoramic view (Panorex) has become the single most useful radiograph for assessment of the entire mandible. Computed tomography scans provide the best evaluation of severely comminuted and/or displaced condylar fractures.

• A tripod fracture, also called a zygomaticomaxillary complex (ZMC) fracture, is the most common fracture of the zygomatic bone and usually involves:

1.       Zygomaticofrontal suture (or may involve the frontal process of the zygoma)

2.       Zygomaticomaxillary suture

3.       Zygomatic arch

Fourth and fifth components include fractures of the orbital floor or lateral orbital wall and the anterior and lateral maxillary sinus walls. The typical tripod is usually made of four components, making a "tetrapod" a more apt description of the ZMC fracture.

• COMPLICATIONS OF TEMPORAL BONE FRACTURE THAT MAY REQUIRE EARLY INTERVENTION (CLONE MNEMONIC)

1.       Carotid artery injury (penetrating trauma)

2.       Leakage of CSF

3.       Other intracranial complications (e.g., hematoma, temporal lobe injury)

4.       Nerve injury leading to complete facial paralysis

5.       External auditory canal fracture (with significant displacement of bone fragments that threaten to cause a canal stenosis)

• The H-type TEF (absence of atresia) often presents later with chronic feeding difficulties and recurrent respiratory distress and/or pneumonia. Diagnosis can be made with a barium esophogram.

• Heliox is a mixture of helium and oxygen. The lowered density of this mixture reduces airway resistance to turbulent flow and thus decreases flow-resistive work. In addition, the decreased pressure gradient required to produce a specific flow may decrease the tendency of the airway to collapse distal to the obstruction.

Helium-oxygen treatments have been used in several upper airway conditions, including postextubation stridor, tracheal stenosis or compression, status asthmaticus, and angioedema. They serve as a temporizing measure before definitive intervention can be employed and can be extremely helpful in "buying some time" in the emergency setting.

• Otolaryngologic problems with craniosynostosis syndromes:

Apert, Crouzon, Pfeiffer, Saethre-Chotzen, or Jackson-Weiss syndromes, often have highly arched palates, middle ear disease, and conductive hearing loss. Furthermore, some affected children have upper airway abnormalities, such as choanal atresia and tracheal rings.

• chromosomal defects with otolaryngologic consideration:

Trisomy 21, trisomy 13, cri du chat syndrome (5p-), Wolf-Hirschhorn syndrome (4p-), and deletion of the long arm of chromosome 18 (18q-). Trisomy 13 and Wolf-Hirschhorn syndrome are associated with cleft lips with or without cleft palates. The typical, mewing cry described in infants with cri du chat syndrome is ascribed to abnormal laryngeal development. In patients with 4p deletion, the endolarynx is narrow and diamond-shaped, with a persistent interarythroid cleft. People with 18q- are at risk for narrow or atretic ear canals, contributing to frequent otitis media and deafness.

• Garcia is therefore generally credited with being the first to visualize the human larynx, although it is probably more correct to say that he was the first to popularize the procedure, provided an example of an early marketing success, and is regarded as the "father of laryngology."

• Gyorgy von Békésy, a Hungarian, won the Nobel Prize in 1947 for developing the semiautomatic audiometer. This advancement produced threshold measurements, which were valuable in the differentiation of conductive and sensorineural hearing loss.

Another winner was Robert Bárány, who was awarded the 1914 Nobel Prize for his work on the physiology and pathology of the vestibular apparatus. He was a prisoner of war in Russia (WWI) and was in a prisoner of war camp in Turkestan when he learned of the award and was released to receive it.

• Rhinoplasty is the second most frequently performed surgical operation in facial plastic and reconstructive surgery, exceeded only by blepharoplasty.

• Goode's ratio is the mathematical relationship between nasal projection and nasal length. Projection is typically 0.55-0.6 of length. In rhinoplasty, iatrogenic loss of tip support can unfavorably alter the ratio.

• Dermatochalasis is the redundancy and draping of the eyelid skin in the aged face. It causes pseudoptosis when it progresses to the point that skin drapes over the upper eyelashes and causes visual field defects. Dermatochalasis may occur in younger people who have a familial predisposition for upper eyelid skin redundancy and/or orbital fat hypertrophy.

Blepharochalasis is rare variant of angioneurotic edema in which recurrent episodes of eyelid edema eventually lead to chronic changes in eyelid skin elasticity and pigmentation as well as upper lid ptosis. It should not be confused with dermatochalasis.

• Temporomandibular disorders (TMDs), also called craniomandibular disorders, encompass a variety of disorders affecting not only the temporomandibular joint (TMJ) but also areas extrinsic to the joint. TMD has traditionally been described as a constellation of related pathologic changes that produce musculoskeletal symptoms. These may present as pain associated with jaw function, limited range of mandibular motion, masticatory muscle tenderness, and TMJ tenderness. TMD has a very broad interpretation and describes a general population of patients suffering from abnormal and usually painful function of the jaw muscle and joints. This is not a homogeneous group of patients, as many different causes and mechanisms of pain are responsible for similar presentations. Temporomandibular joint disease (internal derangement) implies intra-articular pathology and dysfunction, which may occur with or without musculoskeletal problems.

• Müller's maneuver is performed as part of an extensive physical examination and involves passing the flexible fiberoptic scope into the hypopharynx to obtain a view of the entire hypopharynx and larynx. The examiner then pinches the nostrils closed, and the patient closes his or her lips while attempting to inhale. If the hypopharynx and/or larynx collapse, then the test result is positive. A positive test result means the site of upper airway obstruction is likely below the level of the soft palate, and the patient will probably not benefit from a uvulopalatopharyngoplasty (UPPP) alone. Tongue base procedures may be necessary.

• tests for OSA: The Epworth Sleepiness Scale, pulse oximetry, home sleep studies, multiple sleep latency tests, sleep endoscopy, and sleep fluoroscopy have all been used to evaluate OSA. But, polysomnography (a "sleep study") is the most sensitive and specific test in the evaluation of OSA.

• Medicinal leeches have been around for 2500 years. In addition to drawing off blood (approximately 50 mL of blood "ooze" in 48 hours for one leech), there are vasodilator and anticoagulant properties to leech saliva, which provide the real therapeutic benefits. The patient should also receive antibiotic prophylaxis for Aeromonas hydrophila, a contaminant of the leech saliva.

• Kasabach-Merritt syndrome is an unusual but feared entity related to large hemangiomas. A disseminated intravascular coagulation-like syndrome with platelet trapping is characteristic. It is treated by transfusion of clotting factors and platelets as necessary, in addition to addressing the responsible lesion.

• Paragangliomas have a low potential for malignancy. They are typically composed of two cell types: epithelioid cells (Zellballen) in nests separated in a trabeculated fashion by vascularized connective tissue and neural elements that are peripherally located. Histologic diagnosis of malignancy is not possible in this tumor. Reported figures range from 2% to 50% based on pathology alone. Thus, most authors agree that histologic appearance does not correlate well with growth behavior. The only admissible criterion for malignancy is the presence of distant metastasis. This runs at a rate of approximately 10%.