Papers by Michael Friduss
cleft lip rhinoplasty has challenged facial plastic surgeons for decades. While many approaches h... more cleft lip rhinoplasty has challenged facial plastic surgeons for decades. While many approaches have been described, few techniques have been able to address the multitude of issues facing these patients. Initially, a medially-based chondrocutaneous flap with a division of the lower lateral cartilage was advocated to improve tip symmetry and attempt to improve vestibular stenosis (5). However, without the ability to rotate skin into the vestibule or remove skin from the alar web, an optimal symmetric result and significant improvement in the nasal airway cannot be achieved. Tajima initially described a technique to fully address the nasal alar webbing by incising the skin across the alar-columellar web (6). There was reluctance to accept the inverted U incision across the alar-columellar web as instrumentation of the nasal soft triangle is often ill-advised. However, this incision enables removal of the alar web with the resulting ability to rotate the skin into the deficient vestib...
Endotracheal hemorrhage from the innominate artery is, fortunately, a rare problem encountered by... more Endotracheal hemorrhage from the innominate artery is, fortunately, a rare problem encountered by the otolaryngologist. We present a patient with a tracheal–innominate artery fistula secondary to delayed rupture of a traumatic innominate artery aneurysm. The differential diagnosis of innominate artery hemorrhage is discussed, as is the management of this potentially lethal event. We propose, as the treatment of choice, cessation of hemorrhage through the use of a cuffed endotracheal tube, followed by ligation of the innominate artery using cardiopulmonary bypass. These techniques were used in this patient with a successful outcome.
The Laryngoscope, Jun 12, 2016
The prevalence of multiglandular disease (MGD) of the parathyroid has been reported to be higher ... more The prevalence of multiglandular disease (MGD) of the parathyroid has been reported to be higher in patients with primary hyperparathyroidism and low baseline intact parathyroid hormone (PTH) levels (<100 pg/mL). Low baseline PTH is associated with lower localization rate and positive predictive value with both preoperative sestamibi and ultrasound. This study sought to evaluate our experience with four-dimensional computed tomography (4D-CT) for the localization of abnormal parathyroid glands, including MGD, in patients with low baseline intact PTH (LBiPTH). A single institution case series. A case series of patients with primary hyperparathyroidism with low baseline PTH or an inconclusive sestamibi, who underwent surgery with a single surgeon from April 2012 to June 2015 following 4D-CT to help with abnormal gland localization. We identified 14 patients who underwent a 4D-CT in the setting of primary hyperparathyroidism and LBiPTH. A sestamibi scan had been ordered in 71% and w...
The Laryngoscope, 2009
Secondary cleft lip rhinoplasty has challenged facial plastic surgeons for decades. While many ap... more Secondary cleft lip rhinoplasty has challenged facial plastic surgeons for decades. While many approaches have been described, few techniques have been able to address the multitude of issues facing these patients. Initially, a medially-based chondrocutaneous flap with a division of the lower lateral cartilage was advocated to improve tip symmetry and attempt to improve vestibular stenosis (5). However, without the ability to rotate skin into the vestibule or remove skin from the alar web, an optimal symmetric result and significant improvement in the nasal airway cannot be achieved. Tajima initially described a technique to fully address the nasal alar webbing by incising the skin across the alar-columellar web (6). There was reluctance to accept the inverted U incision across the alar-columellar web as instrumentation of the nasal soft triangle is often ill-advised. However, this incision enables removal of the alar web with the resulting ability to rotate the skin into the deficient vestibule. Vissarionov was the first to suggest that the excess skin could also be transposed into the atretic nasal vestibule from the lip scar (2). This technique allows two-point fixation of the dome allowing further improvement in the vestibular stenosis and resulting nasal airway. Cartilage grafting may be helpful in some instances (7,8). The grafting can help improve nasal tip symmetry and provide strength to columella. However, the excess tissue can result in a bulbous tip. This can frequently cause a displeasing cosmetic result. In our study, we compared the medially-and laterally-based chondrocutaneous flaps. The medially-based flap was somewhat successful in increasing symmetry of the vestibule and dome, however, the alar-columellar web and vestibular stenosis were insufficiently addressed. With the laterally-based flap, patients had markedly improved symmetry of the nasal ala and tip. Further, all patients had improvement in the ability to breathe through their cleft side. Because of our small sample sizes, our findings were not statistically significant. However, they do suggest better results with the laterally-based chondrocutaneous flap.
Annals of plastic surgery, 1986
A patient who sustained frontal sinus fracture and who earlier had undergone an osteoplastic fat ... more A patient who sustained frontal sinus fracture and who earlier had undergone an osteoplastic fat obliteration procedure is described. The literature is reviewed and recommendations are made for management of this and other cases of frontal sinus fractures with posterior table involvement.
American journal of otolaryngology
The hypopharynx and cervical esophagus are particularly vulnerable to intubation trauma. Contribu... more The hypopharynx and cervical esophagus are particularly vulnerable to intubation trauma. Contributing factors include hasty intubation by inexperienced personnel; the use of curved, beveled endotracheal tubes containing stylets; malpositioning of the head, and the application of cricoid pressure. Iatrogenic pharyngoesophageal perforations may go unsuspected until characteristic signs and symptoms are recognized. These include cervical pain, fever, dysphagia, leukocytosis, subcutaneous emphysema, and pneumomediastinum. We present three cases that illustrate important points in recognizing, evaluating, and treating pharyngoesophageal perforations. The third case presents a chronic cervical esophageal perforation with secondary pseudodiverticulum, requiring resection of the pseudodiverticulum and a primary sternocleidomastoid muscle flap repair of the cervical esophageal defect. To our knowledge, this technique has not previously been reported.
Laryngoscope, 2008
Objectives/Hypothesis: To review the clinical significance of primary hyperparathyroidism during ... more Objectives/Hypothesis: To review the clinical significance of primary hyperparathyroidism during pregnancy including the maternal, fetal, and neonatal sequelae. Additionally, to discuss treatment options and describe three cases where surgical parathyroidectomy was successful for treatment of hyperparathyroidism refractory to medical management during pregnancy. Study Design: Retrospective. Methods: We reviewed three cases of hyperparathyroidism during pregnancy and reviewed the literature. Results: Three women underwent surgical parathyroidectomy during their second and third trimester of pregnancy without any maternal, fetal, or neonatal complications. Conclusions: Hyperparathyroidism during pregnancy may be safely treated with surgical parathyroidectomy if refractory to medical management with low operative risk when performed during the second trimester. This surgical option should be considered in light of the known maternal, fetal, and neonatal risks because of the hypercalcemic state in pregnancy.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 1994
Obstructive sleep apnea syndrome is a complex disorder that has been associated with a variety of... more Obstructive sleep apnea syndrome is a complex disorder that has been associated with a variety of abnormalities of the upper airway, including tonsil and adenoid hypertrophy, nasal obstruction, retrognathia, and macroglossia. The cause of the airway obstruction in acromegaly is believed to be related to osseous and soft-tissue changes surrounding the upper airway, which lead to narrowing and subsequent collapse during sleep. We describe the results of treatment in seven patients with both sleep apnea and acromegaly. Four patients were treated by transsphenoidal hypophysectomy alone with a resolution of sleep apnea syndrome. One underwent hypophysectomy followed by postoperative radiation therapy, which reduced his apnea. Three patients underwent unsuccessful uvulopalatopharyngoplasty. Successful treatment of the primary disorder, in this case acromegaly, resulted in improved breathing during sleep in five patients. This series would suggest that acromegalic patients with sleep apnea...
Otolaryngology-Head and Neck Surgery
A database of questions and answers has been developed to assist residents in reviewing current t... more A database of questions and answers has been developed to assist residents in reviewing current topics in otolaryngology-head and neck surgery. Each question/item has an associated answer, general category, specific category, and reference that allows cross-referencing on the computer system. The user can search the database for categories of interest and obtain a specific subset of questions. This allows an efficient means of knowledge acquisition and review for Board examinations. Additional data entry is also facilitated to expand the database as desired. Currently there are more than 2300 items in the database.
Otolaryngology - Head and Neck Surgery, 1995
We establish criteria for aesthetic forehead flap reconstructions and evaluate the effect of math... more We establish criteria for aesthetic forehead flap reconstructions and evaluate the effect of mathematical models and computer simulation of the operation in preoperative and perioperative planning. We study a case series of 13 patients in an academic tertiary referral medical center. Most patients had nasal defects after Mohs' surgery for tumor ablation. Patients were followed up for 2 years after reconstructive surgery. Three patients underwent midline forehead flap nasal reconstructions, and t0 patients underwent paramedian forehead flap nasal reconstructions. We used patient satisfaction and physician evaluation of aesthetic form and function restoration as the main outcome measures. There were no major complications. Minor complications included short-term pincushioning in all patients, scar contrac-Lure that resolved after 8 months in one patient, and forehead necrosis after primary closure of the upper forehead in one patient. Computer simulation correlated two-dimension flap design to the transposition process. We conclude that the forehead flap is the optimal reconstructive modality for resurfacing large nasal defects. The paramedian forehead flap is superior to the midline forehead flap for nasal reconstruction, especially for distal tip reconstructions. Mathematical models and computer simulation of the reconstructive procedure that relate the two-dimensional flap design to the transposition process reveal subtle geometric relationships of the flap transposition that facilitate the design of the optimal flap for reconstruction. (OTOLARYNGOL HEAD NECK SURG 1995; 113: 740-7.) rain I¥1any surgeons consider forehead skin the best match of color and texture in reconstructing nasal defects. Unfortunately, because of the thickness of forehead skin, composite grafts cannot survive reliably solely on imbibition. Thus surgeons traditionally transpose the tissue from the forehead onto the nose by a two-stage procedure: the first stage transfers the tissue on a vascular pedicle, and the second stage divides the pedicle after inosculation and
Uploads
Papers by Michael Friduss