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Introduction: Although free tissue transfer is thought the best option for head and neck reconstruction, the pectoralis major myocutaneous flap (PMMCF) remains an important alternative method. The aim of this study was to assess the use of the PMMCF with the prevertebral fascia to close a pharyngeal defect., Materials and Methods: This was a retrospective study of 30 patients who underwent circumferential pharyngeal defect reconstruction with a U-shaped PMMCF from 2009 to 2018. The flap was primarily used to reconstruct defects after tumor extirpation., Results: One patient (3.3%) died of an acute myocardial infarction within 24 h of the operation. Six cases (20.0%) developed a pharyngocutaneous fistula; one of them required debridement, while the others spontaneously healed with conservative treatment. Seven cases (23.3%) developed tracheal stomal stenosis. Twenty-four (80.0%) of these cases could eat a regular diet, while the other five cases needed tube feeding., Conclusion: In patients with late-stage laryngopharyngeal cancer, reconstructing circumferential pharyngeal defects with the U-shaped PMMCF is an expedient alternative to free tissue transfer.

Objective: Montelukast is a selective and orally active leukotriene D 4 receptor antagonist often used in treating asthma and allergic rhinitis. Montelukast nasal spray was developed to avoid systemic adverse effects of the drug in vitro. However, the effects of montelukast on human nasal mucosa are not yet fully explored and potential nasal vascular side effects of the drug merit further exploration. First, the effects of montelukast on vasocontractile responses generated by smooth muscles in the vascular structures of human nasal mucosa were investigated directly in vitro., Methods: This study examined the effects of montelukast on human nasal mucosa in terms of mucosa resting tension, vasoconstriction caused by 10 - 6 M methoxamine as a sympathetic mimetic, and electrically induced vasoconstrictions., Results: The results indicated that addition of methoxamine to the incubation medium caused the nasal mucosa to vasocontract in a dose-dependent manner. Addition of montelukast at doses of 10 - 5 M or above elicited a significant vasodilation response to 10 - 6 M methoxamine-induced vasoconstriction. Montelukast could not inhibit electrical field stimulation-induced spike vasoconstriction. Moreover, increase in concentration of montelukast had minimal effect on basal tension of nasal mucosa., Conclusions: The study indicated significant vasodilation on human nasal mucosa under high concentrations of montelukast with a probable α-adrenoceptor antagonism. Hence, the nasal activity of α-adrenergic agonist nasal spray for nasal obstruction may be reduced in those using concomitant (oral or local spray) montelukast.

Objective: Nasal septal abscess is an uncommon condition but it can cause potentially life-threatening intracranial complications and cosmetic nasal deformity., Methods: We analyzed ten years of cases to determine the optimal diagnostic and therapeutic modalities. A retrospective review of case notes from Tri-Service General Hospital archives was performed. Records of six patients diagnosed with nasal septal abscess, who were treated from September 2007 to August 2017 were retrospectively reviewed. Patients' clinical symptoms, etiology, diagnostic methods, bacteriology, antibiotic and surgical treatment were recorded and analyzed., Results: Out of six patients diagnosed with nasal septal abscess, three were male and three were female. Ages ranged from 19 to 75 years (mean 51 years). The most common symptoms at presentation were nasal pain and nasal obstruction. Typical etiologies were trauma or acute sinusitis, but uncontrolled diabetes mellitus was also an important etiology. In the series of six patients, four of them had positive findings of abscess and in drainage, had the following bacterial cultures: Staphylococcus aureus (two cases), methicillin-resistant S. aureus (one case), and Klebsiella pneumoniae (one case). In addition to antibiotic treatment, all patients underwent surgical drainage and had complete resolution of disease without intracranial complications during at least 1 year of follow-up. However, two out of the six patients developed saddle nose deformity., Conclusions: This study highlights that: 1. In view of the rapidly increasing number of diabetes mellitus cases, uncontrolled diabetes mellitus is an important etiology of nasal septal abscess. 2. Although S. aureus is the most common pathogen, we must pay attention to methicillin-resistant S. aureus (MRSA) to prevent severe complications and patients who are at increased risk for MRSA colonization should be administrated antibiotics against MRSA initially. 3. Nasal septal abscess should be managed with parenteral broad spectrum antibiotics, appropriate drainage and immediate reconstruction of the destructed septal cartilage with autologous cartilage graft, to prevent serious intracranial complications and cosmetic nasal deformity.

The frontal sinus outflow pathway is complex and can be influenced by the configuration of the uncinate process (UP). The UP can attach superior to the lamina papyracea, skull base, and middle turbinate. The factors associated with superior attachment remain unclear. This study analyzed the relationships between different types of superior UP attachment and characteristics of the surrounding structures including the agger nasi cell, skull base, and middle turbinate. This retrospective study utilized computed tomography images of 836 sides with identifiable sinus structure from 434 Taiwanese patients. Types of superior UP attachment, height of the ethmoid cribriform plate, prevalence of agger nasi cell, and degree of pneumatization of the middle turbinate were analyzed. In the current study, neither the presence of an agger nasi cell nor height of the cribriform plate had significant relationship with superior UP attachment type. However, UP attachment type was statistically significantly associated with pneumatized middle turbinate (PMT) type (p < 0.01). The PMT group had a higher incidence of UP attachment to the middle turbinate (38%) than the non-PMT group (18%). In the extensive PMT group, the incidence of UP attachment to the middle turbinate was high to 49%. In conclusion, superior UP attachment to the middle turbinate was associated with pneumatization of the middle turbinate. The UP has a greater tendency to attach to the middle turbinate in cases with more PMT.

Endoscopic septoplasty has become the favored approach for the treatment of a deviated septum. Careful septal dissection results in less bleeding, clear endoscopic view, shortened operative time, and fewer postoperative complications. We describe our 5-year experience of using an 8 French Frazier suction tube for submucosal dissection compared with the traditional septoplasty. A total of 434 patients who underwent septoplasty were recruited. The patients in the study were divided into two Groups 1 and 2 based on the employed surgical techniques to treat deviated nasal septum: traditional septoplasty (Group 1: 105 patients) and suction-tube-assisted endoscopic septoplasty (Group 2: 329 patients). All the patients were followed up for a minimum of 6 months. No statistically significant differences could be traced between the groups in any demographic factor, regarding the gender, age, and the intraoperative and postoperative complications. A significantly shorter operative time was found in Group 2 (P < 0.001). The overall incidence of minor complications was 6.6% in Group 1 and 4.6% in Group 2. The suction-tube-assisted dissection technique is found to be a surgical alternative, effective with a significantly shorter operating time, and economical option in septal surgery.

Head and neck surgeries often accompany with moderate-sized defects that require time-consuming reconstructions by free flaps. The submental flap is a versatile and time-effective option for reconstruction of orofacial defects providing acceptable cosmetic and functional results without requiring microsurgical techniques. A retrospective case series study of patients who underwent reconstruction with the submental flap between 2009 and 2013 was conducted. There were 36 patients (33 men and 3 women), with a mean age of 56.4 years, enrolled in this study. The primary lesion sites included oral cavity (24 patients), pharynx (8 patients), larynx (2 patients), neck (1 patient) as well as maxillary sinus (1 patient). All flaps were harvested as the myocutaneous flaps. All donor sites were closed primarily without the need of additional surgery. No complete loss of the flap was encountered and two cases developed marginal necrosis of the flap. The submental flap had a reliable pedicle and had minimal donor-site morbidity. It is an excellent flap option for patients with small- to medium-sized defects in head and neck region.

The purpose of this study is to evaluate the benefits of the intraoral approach for removal of the submandibular gland (SMG) by comparing it with the usual method of the transcervical approach. Sixteen patients who required SMG resection for benign disorders were divided into two surgical groups who underwent surgery via the intraoral (n = 8) or transcervical (n = 8) approach. The intraoral approach (IOA) consisted of an incision on the floor of mouth from the caruncle of Wharton's duct to the retromolar trigone while the transcervical approach (TCA) consisted of an incision along the natural skin crease overlying the gland. The operation time, hospital stay, complications, and cosmetic appearance were compared between groups. The mean operation time of the IOA group was significantly longer than that of the TCA group, but decreased gradually with surgical experience. The mean hospital stay of the IOA group was significantly shorter than that of the TCA group. Most patients (88 %) of the IOA group experienced sensory defects of the lingual nerve, but these symptoms were temporary. No lasting complications were noted in the IOA group; however, one patient of the TCA group had permanent paralysis of the marginal mandibular branch of the facial nerve. The incision scars were invisible owing to the location on the mouth floor in the IOA group, whereas they were apparent even on the natural skin crease of the neck in the TCA group. In conclusion, the SMG can be removed safely and effectively by IOA with the avoidance of an external scar and of injury to the marginal mandibular nerve. We suggest that the IOA be substituted for the TCA as the primary procedure for removal of the SMG in suitably selected patients.

The submental flap has rekindled interest in using cervical flaps for reconstruction of head and neck defects. In this article, the authors present their experience of using this flap for hypopharyngeal defects after laryngopharyngectomy. This is a retrospective study of six patients who underwent hypopharyngeal defect reconstruction with submental flap from 2008 to 2011, operated upon by a single surgeon (JC Lee). The flap was used primarily to reconstruct defects after tumor extirpation. The maximum flap size was 12 × 7 cm and the minimum size was 9 × 4 cm (average, 10.5 × 5.3 cm). No flap failures were observed. All the donor site defects were closed primarily. Two patients developed a small pharyngocutaneous fistula that resolved spontaneously. No other complications were observed. After speech reeducation, all achieved a good-quality, understandable artificial voice. All patients were able to eat by mouth without the need for tube feeding. The submental flap is an excellent alternative in the reconstruction of hypopharyngeal defects because of its reliability, versatility, pliability, and relative ease of application. Our initial reports confirm that this kind of reconstruction is feasible and time-saving, and restored a good quality of life.

The incidence of head and neck cancers in patients with an initial presentation of deep neck infection is unclear and may be underestimated. Thus, the aim of this study was to assess the incidence of head and neck cancers initially manifested as deep neck infection. Also, the possible risk factors and pathophysiology are discussed. This study was a retrospective medical chart review in a tertiary referral center. A total of 81 consecutive patients admitted with a diagnosis of deep neck infection over a 46-month period were analyzed. The demographic data, physical examinations, laboratory findings, radiographic studies, and pathology report were analyzed. Among the 81 deep neck infection patients, head and neck cancers were histologically demonstrated in four patients (4.9%) with the initial symptom of a painful neck mass. The incidence of head and neck cancer initially manifested as deep neck infection was found to increase in patients aged over 40 years (6.7%; 3/45 vs. 2.8%; 1/36). A detailed history of all patients with deep neck infection should be taken. Furthermore, endoscopic examination, thyroid examination and routine pathological examination should be performed, especially in those aged over 40. Also, careful explanation to the patient and his/her family about the possibility of underlying head and neck cancer (incidence 1-5%) may be needed. If the neck swelling diminishes, but does not disappear completely after full course of antibiotics, repeated fine needle aspiration, endoscopy, or image study should be considered.

The purpose of this study was to present our experiences with correction of twisted nose in Asian patients using a new and simple classification and a surgical algorithm. A classification and standard surgical algorithm was followed to determine treatment strategies for 384 patients with twisted nose between June 2001 and July 2009. A retrospective chart review from the Tri-Service General Hospital archives was performed to collect patients' data and surgical details. A follow-up self-evaluation survey regarding satisfaction with nasal function and esthetics was distributed to all participants. Preoperative and postoperative standardized photography of the face were evaluated to judge objectively the esthetic outcomes of the surgery. There were 147, 131, and 106 patients in Type I, Type II, and Type III patients, respectively. The percentages of functionally satisfied and very satisfied patients were 95.2, 93.9, and 93.4% in Type I, Type II, and Type III groups, respectively. The percentages of esthetically satisfied or very satisfied patients were 89.1, 88.5, and 87.7% in Type I, Type II, and Type III groups, respectively. There were only 2 patients with type III deviation with residual deviation of dorsum objectively who were satisfied with the results after undergoing a revision rhinoplasty. Aside from residual deviation, the postoperative periods were uneventful and without major complications. We propose a new and simple classification and surgical algorithm to optimally correct twisted nose deformities for Asian patients. The classification and surgical algorithm, which is simple and reproducible especially for beginner, guides surgical decisions that yield consistently satisfactory functional and esthetic results.

The purpose of this report is to describe a novel technique for endoscopic vidian neurectomy (EVN) based on preoperative computed tomography (CT) classification of the vidian canal (VC), and to present anatomical and surgical findings from an initial series. Retrospective study, consisting of medical chart review and patient interviews, of all preoperative CT-guided EVN procedures was performed from 2006 to 2010 at a tertiary-care medical center. A total of 89 patients with intractable rhinorrhea (77 males and 12 females, mean age 29 years, age range 16-57 years) underwent bilateral EVN. Configuration of the VC was classified into three types based on preoperative CT findings. The technique for surgical access of each of these configurations is presented. The most common configuration of the VC was type 2 (47%). A wide, direct, and safe exposure of the vidian nerve was achieved in all cases. 84 of 89 patients completed the questionnaires regarding the postoperative improvement in quality of life. Follow-up ranged from 2 to 42 months, with an average of 19.6 months. 77 of 84 (91.7%) patients were satisfied with their surgical result. Two patients underwent revision ETSVN due to relapsed symptoms. With the help of a preoperative CT scan of the paranasal sinuses, the vidian nerve can be identified precisely via an endoscopic intrasphenoidal or transsphenoidal approach, which provides an easy and reliable way to perform vidian neurectomy.

Tonsillectomy is one of the most common operations performed by otolaryngologists. Sore throat, otalgia, fever, dehydration, uvular edema, and tonsillar hemorrhage are common complications. Hematoma of the mouth floor, an unusual complication, was reported. A 21-year-old man presented with a soft, dark-red swelling of the mouth floor three days after undergoing tonsillectomy. The hematoma of the mouth floor subsided spontaneously 2 weeks later. The complication in this case was most likely caused by the blood vessel insult, which resulted from suspension of the mouth with tongue retraction during surgery. This procedure should be done carefully to prevent this complication. Hematoma of the mouth floor can cause airway obstruction, and if present, health providers should be alert to the possibility of airway compromise.