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Subcutaneous emphysema of the head and neck after otologic surgery is exceedingly rare. The mechanism relates to the intimate relationship of the temporomandibular joint to the external auditory canal. We present a rare case of subcutaneous emphysema after otologic surgery for ear disease. An astute clinical index of suspicion coupled with prompt treatment can help minimize morbidity and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Importance: Repair of nasal septal perforations is challenging regardless of surgical technique due to their location and the health of surrounding tissue. There is currently no surgical procedure which is completely effective in the treatment of anteriorly located perforations., Objective: To report a novel method of closing anterior septal perforations using an inferiorly based mucosal rotation flap and an acellular dermal interposition graft, as well as expand upon a previous series., Design: The study includes patients who underwent surgical repair for septal perforations by the senior author between 2003 and 2015., Setting: The study took place at MetroHealth Medical Center in Cleveland, Ohio., Participants: Thirty-nine patients (15 male) with septal perforations of various size and etiology underwent endonasal repair using rotation flaps. The average age of patients was 42-years old (range 10-67years). INTERVENTION FOR CLINICAL TRIALS OR EXPOSURE FOR OBSERVATIONAL STUDIES: Five patients had perforations such that we used inferiorly based flaps, while 35 cases utilized posteriorly based flaps. Acellular dermis was used in addition to a unilateral rotation flap., Main Outcomes and Measures: The primary outcome desired was a complete closure of the septal perforation. The success, or lack thereof, was monitored after healing from surgery., Results: Thirty-seven of the forty surgical procedures demonstrated complete closure of the perforation, a 92.5% success rate. Perforations were separated based upon size. Small perforations (<1cm) had a 93.3% success rate, medium (1-2cm) 88.9%, and all seven large perforations (>2cm) were closed successfully. In addition, all five of the inferiorly based procedures resulted in complete closure of the perforation. Of the failed repairs, one required revision surgery to repair a recurring perforation, while the other two were asymptomatic following the procedure., Conclusions and Relevance: Endonasal repair using inferiorly based mucosal rotation flaps coupled with an acellular dermal interposition graft is a valid technique for the repair of septal perforations. Posterior rotation flaps are preferred due to major septal blood supply from branches of the sphenopalatine artery, but inferiorly based flaps are also viable options for repair for perforations located in the anterior septum., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Septal ulceration is a mucositis involving the mucous membranes of the nasal septum. Patients often complain of nasal irritation, crusting, and epistaxis. Presently, there is no gold standard for the treatment of septal ulcerations. Currently described therapies include local debridement, septal dermoplasty, septal flap reconstruction, and cadaveric dermal graft repair; however, no therapy has demonstrated a consistent improvement of symptoms. We present a novel approach for the treatment of chronic septal ulceration, using an extracellular matrix scaffold (MatriStem® Wound Care Matrix, ACell, Inc.) to repair unilateral partial septal mucosal defects., Methods: This is a retrospective chart review of three patients with age range from 42 to 74years. All three patients underwent several years of unsuccessful conservative medical management and two patients had prior unsuccessful septoplasty and septal ulcer debridement procedure. There are no complications noted in the post-operative period., Result: All three patients had complete symptom relief on post-operative visit after chronic septal ulceration repair using an extracellular matrix scaffold mechanism. Patients were able to manage with conservative nasal regiment after surgery with significant improvement on quality of life., Conclusion: The use of extracellular matrix scaffolding provides the nasal septum with a framework for the in-growth of healthy mucosa over ulcerated areas. We propose this as a new treatment approach for patients who failed conservative medical management. Chronic septal ulcerations can be healed to provide improved quality of life to patients., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Keloid scars pose a surgical challenge in the region of the head and neck. We present a rare case of a large infected and recurrent neck keloid that failed multiple prior reconstructive attempts. Ultimately, the tissue was resected and the surgical bed was repaired with a lateral arm microvascular free flap. This repair emphasizes the need for adequate coverage of the defect while maintaining neck mobility, ease of swallowing, and cosmesis. This is the second report in the literature of free tissue transfer as treatment for a large keloid scar, and the first to show the feasibility of early post operative low dose irradiation of the surgical bed., (Published by Elsevier Inc.)

Mucoceles are benign, epithelial-lined mucous cysts. Commonly mucoceles form secondary to obstruction of a sinus outflow tract or from mucosal gland entrapment from chronic infection, inflammation, iatrogenic trauma, external trauma, or neoplasm. We present a rare case of a nasal mucocele in a 37-year old male arising from a remote history of maxillofacial trauma. To our knowledge, mucoceles associated with nasal bone fractures have not been reported in the literature., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Foreign body impactions in the aerodigestive tract are common, but have the potential for serious complications. A foreign body may disrupt the mucosal lining and migrate regionally thereby risking impingement or injury to critical neurovascular structures in the cervical region. It is important to recognize potential complications that may arise from luminal compromise. In such cases, expeditious surgical treatment is warranted., (Copyright © 2013 Elsevier Inc. All rights reserved.)