Surg ica l At lasof

PEDIATRICOTOLARYNGOLOGY

with 900 illustrations

CHARLES D. BLUESTONE, MDEberly Professor of Pediatric OtolaryngologyUniversity of Pittsburgh School of Medicine

Director, Department of Pediatric OtolaryngologyChildrens Hospital of Pittsburgh

Pittsburgh, Pennsylvania

RICHARD M. ROSENFELD, MD, MPHProfessor of Clinical OtolaryngologySUNY Downstate Medical Center

Director, Division of Pediatric OtolaryngologyDepartment of Otolaryngology

Long Island College Hospital and University Hospital of BrooklynBrooklyn, New York

2002BC Decker Inc

Hamilton London

Surg ica l At lasof

PEDIATRICOTOLARYNGOLOGY

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2002 Charles D. Bluestone and Richard M. Rosenfeld

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any formor by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission fromthe publisher.

02 03 04 / FP / 6 5 4 3 2 1

ISBN 1-55009-133-6Printed in Canada

Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein, including choiceof drugs and drug dosages, is in accord with the accepted standard and practice at the time of publication. However, sinceresearch and regulation constantly change clinical standards, the reader is urged to check recent publications and the productinformation sheet included in the package of each drug, which includes recommended doses, warnings, and contraindications.This is particularly important with new or infrequently used drugs.

PREFACE

Surgical Atlas of Pediatric Otolaryngology is a unique and comprehensive ref-erence for clinicians who care for infants and children with disorders of theears, nose, throat, head, neck, and related structures. Over 200 proceduresare described in 650 figures in 900 parts, with step-by-step instructions forpatient preparation, surgical techniques, postoperative care, and preventionof complications. Major sections cover all relevant procedures including oto-logic, rhinologic, oral and pharyngeal, and head and neck surgeries,endoscopy and airway surgery, and plastic and reconstruction surgery.

Osler once quipped, There are only two sorts of doctors: those whopractice with their brains, and those who practice with their tongues. Athird sort had been recruited for this book: those who practice with theirhands. We are fortunate to have recruited the leading experts in the field todescribe in detail how they achieve successful outcomes. All authors areactive surgeons, culled from major childrens hospitals, academic trainingprograms, and pediatric otolaryngology fellowship programs. Their com-bined wisdom has been distilled and organized to promote optimal surgi-cal results.

The Surgical Atlas builds upon a superb foundation established by Atlasof Pediatric Otolaryngology, published in 1995 as a companion to the two-volume classic text Pediatric Otolaryngology. This self-contained work con-tains 15 new chapters on topics including ossiculoplasty, sphenoid sinussurgery, nasal and septal deformities, surgery to correct drooling, velopha-ryngeal insufficiency, soft tissue surgery, and maxillofacial trauma. Morethan 40 additional procedures are illustrated with new artwork, and exist-ing illustrations have been redrawn as needed for improved clarity. The textis completely revised and updated, with extensive reorganization and refor-matting for easy access.

vi Preface

A unique feature of the Surgical Atlas is that technical descriptions arebalanced by in-depth discussions of decision making, patient selection, andclinical management. We emphasize not only how to cut, but also when tocut and when not to cut. Anesthetic considerations, patient preparation,and postoperative care are discussed in detail because they differ in infantsand children as compared with adults. Children have special needs relatedto changes in anatomy, physiology, and psychosocial adjustment duringgrowth and development, and an understanding of these differences canimprove surgical outcomes.

We have structured this book to meet the needs of a diverse audience.Physicians in training will benefit from ready access to how to informa-tion on the gamut of procedures they are likely to encounter in their resi-dence or fellowship. Junior clinicians will have a one-stop refresher forcommonand uncommonprocedures needed for everyday patientcare, with advice and clinical pearls from leading surgical authorities.Senior clinicians will find the book a useful reference for complex or eso-teric procedures, with literature citations for additional details. The beauti-ful line illustrations are a superb didactic aid for clinicians and patients.

We are pleased to have had Jon Coulter prepare most of the artwork thatdescribes in detail the surgical techniques. His expertise has added consis-tency and clarity to the text. We are also indebted to our excellent editori-al assistants, Deborah Hepple and Billy Tang, for their secretarial supportand help in collating the manuscripts. Mr. Tangs efforts and the cost ofillustrations were supported, in part, by Faculty Development Awards fromthe State University of New York Downstate Medical Center in Brooklyn.Last, we thank Sylvan Stool for his invaluable editorial efforts in the pre-cursor, Atlas of Pediatric Otolaryngology.

We hope the reader will benefit from the fine contributions made by theauthors of this text, and that this atlas will enhance the care of infants andchildren who require otolaryngologic surgery.

Charles D. Bluestone, MDPittsburgh, PA

Richard M. Rosenfeld, MD, MPHBrooklyn, NY

January 2002

George Alexiades, MDDepartment of OtolaryngologyNew York University Medical CenterNew York, New YorkChapter 9: Cochlear Implants

Cuneyt M. Alper, MDAssociate Professor of OtolaryngologyUniversity of Pittsburgh School of MedicineDepartment of Pediatric OtolaryngologyChildrens Hospital of PittsburghPittsburgh, PennsylvaniaChapter 26: Tracheotomy

James S. Batti, MDAssistant Professor of Pediatric OtolaryngologyUniversity of ConnecticutDepartment of OtolaryngologyConnecticut Childrens Medical CenterHartford, ConnecticutChapter 4: Ossiculoplasty

Charles D. Bluestone, MDEberly Professor of Pediatric OtolaryngologyUniversity of Pittsburgh School of MedicineDirector, Department of Pediatric OtolaryngologyChildrens Hospital of PittsburghPittsburgh, PennsylvaniaChapter 1: Tympanostomy Tubes and Related ProceduresChapter 2: Approaches to the Middle Ear and MastoidChapter 3: Myringoplasty and TympanoplastyChapter 4: OssiculoplastyChapter 5: Mastoidectomy and CholesteatomaChapter 6: Perilymphatic Fistula and Eustachian Tube SurgeryChapter 31: Otoplasty for the Prominent Ear

Margaretha L. Casselbrant, MD, PhDProfessor of OtolaryngologyUniversity of Pittsburgh School of MedicineDepartment of Pediatric OtolaryngologyChildrens Hospital of PittsburghPittsburgh, PennsylvaniaChapter 26: Tracheotomy

Kenny H. Chan, MDProfessor of OtolaryngologyUniversity of Colorado School of MedicineChairman, Department of Pediatric OtolaryngologyChildrens HospitalDenver, ColoradoChapter 25: Endoscopy of the Upper Aerodigestive Tract

Noel L. Cohen, MDProfessor of OtolaryngologyNew York University School of MedicineChairman, Department of OtolaryngologyNew York University Medical CenterNew York, New YorkChapter 9: Cochlear Implants

William S. Crysdale, MDProfessor of OtolaryngologyUniversity of TorontoOtolaryngologist-in-ChiefHospital for Sick ChildrenToronto, OntarioChapter 11: Nasal and Septal DeformitiesChapter 19: Surgery for Drooling

CONTRIBUTORS

viii Contributors

Michael J. Cunningham, MDAssociate Professor of OtolaryngologyHarvard Medical SchoolDepartment of OtolaryngologyHead and Neck SurgeryMassachusetts Eye and Ear InfirmaryBoston, MassachusettsChapter 20: Cervical AdenopathyChapter 23: Salivary Gland SurgeryChapter 24: Thyroidectomy

Robin A. Dyleski, MDAssistant Professor of Pediatric OtolaryngologyUniversity of Arkansas for Medical SciencesVice Chief, Department of Pediatric OtolaryngologyArkansas Childrens HospitalLittle Rock, ArkansasChapter 33: Cleft Lip and Cleft Palate

Roland D. Eavey, MDAssociate Professor of OtolaryngologyHarvard Medical SchoolDirector of Pediatric OtolaryngologyDepartment of OtolaryngologyHead and Neck SurgeryMassachusetts Eye and Ear InfirmaryBoston, MassachusettsChapter 30: Auricular Repair for Microtia

Jose N. Fayad, MDDepartment of OtolaryngologyManhattan Eye Ear and Throat HospitalLenox Hill HospitalNew York, New YorkChapter 8: Ear Canal Stenosis and Atresia

Norman Friedman, MDAssistant Professor of OtolaryngologyUniversity of Colorado School of MedicineDenver, ColoradoChapter 25: Endoscopy of the Upper Aerodigestive Tract

Ari J. Goldsmith, MDAssociate Professor of OtolaryngologySUNY Downstate Medical CenterDivision of Pediatric OtolaryngologyDepartment of OtolaryngologyLong Island College Hospital and University Hospital

of BrooklynBrooklyn, New YorkChapter 17: Tonsillectomy, Adenoidectomy, and UPPP

Carlos Gonzalez, MDClinical Associate Professor of OtolaryngologyUniversity of Puerto Rico School of MedicineChief, Department of SurgerySan Jorge Childrens HospitalSan Juan, Puerto RicoChapter 16: Surgery of the Tongue

Charles W. Gross, MDProfessor of OtolaryngologyUniversity of Virginia Health SystemDepartment of OtolaryngologyHead and Neck SurgeryUniversity of Virginia Medical CenterCharlottesville, VirginiaChapter 29: Soft Tissue Surgery

Gady Har-El, MDProfessor of Clinical OtolaryngologySUNY Downstate Medical CenterVice Chairman, Department of OtolaryngologyLong Island College Hospital and University Hospital

of BrooklynBrooklyn, New YorkChapter 15: Sphenoid Sinus Surgery

Gerald B. Healy, MDProfessor of Otology and LaryngologyHarvard Medical SchoolOtolaryngologist-in-Chief, Department of

OtolaryngologyChildrens Hospital BostonBoston, MassachusettsChapter 27: Surgery of the Larynx and Trachea

Raymond L. Hilsinger Jr, MDChief, Department of Head and Neck SurgeryKaiser Permanente Medical CenterOakland, CaliforniaChapter 7: Facial Nerve Exploration and Repair

Andrew J. Hotaling, MDProfessor of Otolaryngology and PediatricsChief, Pediatric OtolaryngologyDepartment of OtolaryngologyHead and Neck SurgeryLoyola University Medical CenterChicago, IllinoisChapter 14: Inflammatory Sinonasal Disease

Contributors ix

Kevin J. Hulett, MDDepartment of OtolaryngologyHead and Neck SurgeryLoyola University Medical CenterChicago, IllinoisChapter 14: Inflammatory Sinonasal Disease

Glenn Isaacson, MDProfessor of OtolaryngologyChairman, Department of OtolaryngologyHead and

Neck SurgeryTemple University School of MedicinePhiladelphia, PennsylvaniaChapter 13: Endoscopic Ethmoidectomy and Antrostomy

Robert M. Kellman, MDProfessor of OtolaryngologyChairman, Department of Otolaryngology and Com-

munication SciencesSUNY Health Science Center at SyracuseSyracuse, New YorkChapter 32: Maxillofacial Trauma

Margaret A. Kenna, MDAssociate Professor of Otology and LaryngologyHarvard Medical SchoolDepartment of OtolaryngologyChildrens Hospital BostonBoston, MassachusettsChapter 12: Congenital Nasal Malformations

John Kim, MDDepartment of OtolaryngologyHead and Neck SurgeryUniversity of Michigan Health SystemAnn Arbor, MichiganChapter 34: Craniosynostosis

Charles F. Koopman Jr, MDProfessor of Pediatric OtolaryngologyUniversity of Michigan Medical CenterChief, Division of Pediatric OtolaryngologyDepartment of OtolaryngologyHead and Neck SurgeryC.S. Mott Childrens HospitalAnn Arbor, MichiganChapter 21: Deep Neck Infections

Greg R. Licameli, MDAssistant Professor of Otology and LaryngologyHarvard Medical SchoolDepartment of OtolaryngologyChildrens Hospital BostonBoston, MassachusettsChapter 27: Surgery of the Larynx and Trachea

Scott C. Manning, MDAssociate Professor of OtolaryngologyUniversity of WashingtonChief, Pediatric OtolaryngologyHead and Neck SurgeryDepartment of OtolaryngologyChildrens Hospital & Medical CenterSeattle, WashingtonChapter 10: Epistaxis

Lawrence J. Marentette, MDAssociate Professor of Otolaryngology and NeurosurgeryDirector, Cranial Base ProgramDepartment of OtolaryngologyHead and Neck SurgeryUniversity of Michigan Health SystemAnn Arbor, MichiganChapter 34: Craniosynostosis

Khosrow Mojdehi, MDAssistant Professor of AnesthesiologySUNY Downstate Medical CenterDirector, Division of Pediatric AnesthesiologyDepartment of AnesthesiologyLong Island College Hospital and University Hospital

of BrooklynBrooklyn, New YorkChapter 36: Pediatric Anesthesia

Simon C. Parisier, MDChairman Emeritus, Department of OtolaryngologyManhattan Eye Ear and Throat HospitalLenox Hill HospitalNew York, New YorkChapter 8: Ear Canal Stenosis and Atresia

Stephen S. Park, MDAssociate Professor of OtolaryngologyUniversity of Virginia Health SystemDirector, Division of Facial Plastic and Reconstructive

SurgeryDepartment of OtolaryngologyHead and Neck SurgeryUniversity of Virginia Medical CenterCharlottesville, VirginiaChapter 29: Soft Tissue Surgery

David M. Polaner, MDAssociate Professor of AnesthesiologyUniversity of Colorado School of MedicineDenver, ColoradoChapter 25: Endoscopy of the Upper Aerodigestive Tract

x Contributors

Reza Rahbar, DMD, MDInstructor in Otology and LaryngologyHarvard Medical SchoolDepartment of Otology and LaryngologyChildrens Hospital BostonBoston, MassachusettsChapter 12: Congenital Nasal Malformations

Mark A. Richardson, MDProfessor and ChairmanDepartment of OtolaryngologyHead and Neck SurgeryOregon Health and Science UniversityPortland, OregonChapter 22: Congenital Malformations of the Neck

Keith H. Riding, MDClinical ProfessorUniversity of British ColumbiaStaff OtolaryngologistBritish Columbia Childrens HospitalVancouver, British ColumbiaChapter 25: Endoscopy of the Upper Aerodigestive Tract

J. Thomas Roland Jr, MDDepartment of OtolaryngologyNew York University Medical CenterNew York, New YorkChapter 9: Cochlear Implants

Richard M. Rosenfeld, MD, MPHProfessor of Clinical OtolaryngologySUNY Downstate Medical CenterDirector, Division of Pediatric OtolaryngologyDepartment of OtolaryngologyLong Island College Hospital and University Hospital

of BrooklynBrooklyn, New YorkChapter 17: Tonsillectomy, Adenoidectomy, and UPPPChapter 22: Congenital Malformations of the NeckChapter 35: Information for Parents and Caregivers

Robert W. Seibert, MDProfessor of Pediatric OtolaryngologyUniversity of Arkansas for Medical SciencesDepartment of Pediatric OtolaryngologyArkansas Childrens HospitalLittle Rock, ArkansasChapter 33: Cleft Lip and Cleft Palate

Christopher E. Stevens, MDDepartment of OtolaryngologyHead and Neck SurgeryUniversity of Virginia Health SystemCharlottesville, VirginiaChapter 29: Soft Tissue Surgery

Sylvan E. Stool, MDEmeritus Professor of OtolaryngologyUniversity of Colorado School of MedicineDenver, ColoradoChapter 25: Endoscopy of the Upper Aerodigestive Tract

Sherard A. Tatum, MDAssociate Professor of OtolaryngologyDirector, Division of Facial Plastic and Reconstructive

SurgeryDepartment of Otolaryngology and Communication

SciencesSUNY Health Science Center at SyracuseSyracuse, New YorkChapter 32: Maxillofacial Trauma

Jon B. Turk, MDAssistant Professor of OtolaryngologySUNY Downstate Medical CenterDirector, Facial Plastic and Reconstructive SurgeryDepartment of OtolaryngologyLong Island College HospitalBrooklyn, New YorkChapter 11: Nasal and Septal Deformities

Jay A. Werkhaven, MDAssociate Professor of OtolaryngologyDepartment of OtolaryngologyVanderbilt University Medical CenterNashville, TennesseeChapter 28: Laryngotracheal Laser Surgery

J. Paul Willging, MDAssociate Professor of OtolaryngologyUniversity of Cincinnati College of MedicineDepartment of OtolaryngologyChildrens Hospital Medical CenterCincinnati, OhioChapter 18: Velopharyngeal Insufficiency

OTOLOGIC SURGERY

1. Tympanostomy Tubes and Related Procedures...............................................................................1a. Tympanocentesis ..............................................................................................................1b. Myringotomy ...................................................................................................................4c. Grommet-type tympanostomy tube insertion...................................................................6d. Permanent tympanostomy tube insertion .........................................................................11e. Removal of tympanostomy tubes and myringoplasty........................................................16

2. Approaches to the Middle Ear and Mastoid ..................................................................................21a. Transcanal approach .........................................................................................................21b. Endaural approach............................................................................................................26c. Postauricular approach......................................................................................................32

3. Myringoplasty and Tympanoplasty ................................................................................................39a. Myringoplasty with medial fascia or fat-plug graft............................................................41b. Transcanal medial fascia or fat-plug graft tympanoplasty ..................................................49c. Postauricular medial fascia graft tympanoplasty ................................................................49d. Endaural medial fascia graft tympanoplasty ......................................................................52e. Lateral fascia graft tympanoplasty .....................................................................................58f. Cartilage graft tympanoplasty ...........................................................................................66

4. Ossiculoplasty................................................................................................................................75a. Advancement flap .............................................................................................................78b. Incus interposition............................................................................................................81c. Partial ossicular replacement prosthesis .............................................................................82d. Total ossicular replacement prosthesis...............................................................................83

5. Mastoidectomy and Cholesteatoma ...............................................................................................91a. Simple mastoidectomy......................................................................................................91b. Modified radical mastoidectomy.......................................................................................96c. Radical mastoidectomy.....................................................................................................98d. Congenital cholesteatoma.................................................................................................103e. Posterosuperior quadrant acquired cholesteatoma.............................................................111f. Pars flaccida attic cholesteatoma .......................................................................................117

CONTENTS

xii Contents

6. Perilymphatic Fistula and Eustachian Tube Surgery .......................................................................123a. Congenital perilymphatic fistula.......................................................................................123b. Obliteration of the eustachian tube ..................................................................................129c. Patulous eustachian tube: catheter obstruction .................................................................132

7. Facial Nerve Exploration and Repair .............................................................................................137a. Intratemporal exploration and decompression ..................................................................139b. Intratemporal repair, rerouting, and grafting ....................................................................150c. Extratemporal exploration and repair for lesions...............................................................157d. Extratemporal exploration and repair after trauma ...........................................................171e. Extratemporal repair, rerouting, and grafting....................................................................176

8. Ear Canal Stenosis and Atresia.......................................................................................................185a. Reconstruction of the external ear canal ...........................................................................186b. Skin grafting of the external auditory canal ......................................................................207c. Congenital aural atresia ....................................................................................................211

9. Cochlear Implants .........................................................................................................................221

RHINOLOGIC SURGERY

10. Epistaxis.........................................................................................................................................251a. Local cautery ....................................................................................................................253b. Anterior packing...............................................................................................................253c. Endoscopic-guided cautery ...............................................................................................254d. Posterior packing ..............................................................................................................255e. Arterial ligation.................................................................................................................257

11. Nasal and Septal Deformities.........................................................................................................259a. Closed reduction of nasal fracture.....................................................................................260b. Internal approach for septoplasty......................................................................................264c. External approach for septoplasty .....................................................................................268d. Endonasal approach for rhinoplasty..................................................................................282e. External approach for rhinoplasty.....................................................................................291

12. Congenital Nasal Malformations ...................................................................................................299a. Transnasal repair of choanal atresia ...................................................................................300b. Transpalatal repair of choanal atresia ................................................................................306c. Lateral rhinotomy.............................................................................................................312d. Sublabial approach............................................................................................................315

13. Endoscopic Ethmoidectomy and Antrostomy................................................................................319

14. Inflammatory Sinonasal Disease ....................................................................................................339a. Drainage of septal abscess or hematoma ...........................................................................339b. Antral aspiration and lavage..............................................................................................341c. Caldwell-Luc procedure....................................................................................................342d. External ethmoidectomy...................................................................................................344e. Frontal sinus trephination.................................................................................................346f. Dacryocystorhinostomy....................................................................................................348

Contents xiii

15. Sphenoid Sinus Surgery .................................................................................................................353a. Transnasal transethmoidal sphenoidotomy .......................................................................355b. Direct transnasal sphenoidotomy......................................................................................358

ORAL AND PHARYNGEAL SURGERY

16. Surgery of the Tongue....................................................................................................................367a. Anterior tongue lesions.....................................................................................................367b. Macroglossia .....................................................................................................................369c. Base of tongue lesions.......................................................................................................372d. Frenuloplasty ....................................................................................................................376

17. Tonsillectomy, Adenoidectomy, and UPPP....................................................................................379a. Adenoidectomy.................................................................................................................381b. Tonsillectomy ...................................................................................................................388c. External carotid artery ligation .........................................................................................397d. Uvulopalatopharyngoplasty (UPPP) .................................................................................402

18. Velopharyngeal Insufficiency .........................................................................................................407a. Superiorly based pharyngeal flap.......................................................................................408b. Rolled pharyngeal flap ......................................................................................................415c. Posterior pharyngeal wall augmentation ...........................................................................417d. Sphincteroplasty ...............................................................................................................419e. Lateral port revision, narrowing........................................................................................422f. Lateral port revision, enlarging .........................................................................................424

19. Surgery for Drooling......................................................................................................................427a. Submandibular duct relocation with sublingual gland excision.........................................427b. Submandibular duct relocation.........................................................................................433c. Parotid duct ligation .........................................................................................................436d. Tympanic neurectomy ......................................................................................................438e. Submandibular duct ligation ............................................................................................438

HEAD AND NECK SURGERY

20. Cervical Adenopathy .....................................................................................................................441a. Percutaneous needle biopsy...............................................................................................442b. Cervical lymph node biopsy .............................................................................................448c. Functional (modified) neck dissection ..............................................................................452

21. Deep Neck Infections ....................................................................................................................465a. Submandibular space drainage..........................................................................................468b. Pharyngomaxillary (lateral pharyngeal) space drainage .....................................................472c. Masticator space drainage .................................................................................................475d. Parotid space drainage ......................................................................................................477e. Peritonsillar space drainage ...............................................................................................480f. Visceral space drainage .....................................................................................................482g. Retropharyngeal space drainage ........................................................................................482h. Prevertebral space drainage ...............................................................................................486i. Vascular (carotid) space drainage ......................................................................................487j. Danger space drainage...................................................................................................488

xiv Contents

22. Congenital Malformations of the Necka. Thyroglossal duct cyst ......................................................................................................491b. Cystic hygroma (lymphangioma)......................................................................................496c. First branchial cleft fistula.................................................................................................499d. Pre-auricular pit or fistula .................................................................................................502e. Second and third branchial cleft fistula.............................................................................504f. Fourth branchial pouch sinus ...........................................................................................507g. Fibromatosis colli .............................................................................................................512

23. Salivary Gland Surgery ..................................................................................................................515a. Parotidectomy...................................................................................................................515b. Submandibular gland excision ..........................................................................................526c. Plunging ranula excision...................................................................................................532d. Intraoral ranula excision ...................................................................................................536

24. Thyroidectomy ..............................................................................................................................539

ENDOSCOPY AND AIRWAY SURGERY

25. Endoscopy of the Upper Aerodigestive Tract .................................................................................556a. Pharyngoscopy..................................................................................................................562b. Laryngoscopy....................................................................................................................563c. Bronchoscopy ...................................................................................................................569d. Esophagoscopy .................................................................................................................578

26. Tracheotomy..................................................................................................................................587a. Tracheotomy.....................................................................................................................587b. Tracheocutaneous fistula closure .......................................................................................593

27. Surgery of the Larynx and Trachea.................................................................................................597a. Arytenoidectomy ..............................................................................................................597b. Supraglottoplasty ..............................................................................................................602c. Glottic web excision .........................................................................................................604d. Posterior glottic stenosis repair..........................................................................................606e. Laryngeal separation .........................................................................................................608f. Laryngeal decompression (cricoid split) with hyoid interposition .....................................612g. Augmentation laryngoplasty with cartilage graft ...............................................................616h. Augmentation laryngoplasty with cartilage stent...............................................................620i. Segmental tracheal resection .............................................................................................624j. Cricotracheal resection......................................................................................................626

28. Laryngotracheal Laser Surgery .......................................................................................................633a. Epiglottic cysts..................................................................................................................642b. Vallecular cysts..................................................................................................................644c. Ventricular cysts................................................................................................................646d. Intracordal cysts................................................................................................................648e. Vocal process granulomas .................................................................................................650f. Laryngeal papillomatosis...................................................................................................652g. Laryngeal webs .................................................................................................................654h. Vocal cord nodules ...........................................................................................................658i. Reinkes edema and vocal cord polyps ..............................................................................660

Contents xv

j. Laryngeal and subglottic hemangiomas ............................................................................663k. Subglottic stenosis ............................................................................................................665l. Tracheal stenosis ...............................................................................................................668

PLASTIC AND RECONSTRUCTIVE SURGERY

29. Soft Tissue Surgery ........................................................................................................................671a. Lip repair..........................................................................................................................678b. Auricular repair.................................................................................................................682c. Nasal repair ......................................................................................................................686d. Periorbital repair ...............................................................................................................688e. Parotid duct repair............................................................................................................694f. Facial nerve repair.............................................................................................................694g. Scar revision .....................................................................................................................695

30. Auricular Repair for Microtia ........................................................................................................701

31. Otoplasty for the Prominent Ear ...................................................................................................717

32. Maxillofacial Trauma .....................................................................................................................727a. Coronal incision ...............................................................................................................732b. Superior lid crease incision ...............................................................................................734c. Transconjunctival incision ................................................................................................736d. Vestibular or canine fossa incision ....................................................................................738e. Extraoral mandibular exposure .........................................................................................740f. Intraoral mandibular exposure ..........................................................................................744g. Maxillomandibular fixation ..............................................................................................746h. Rigid internal fixation.......................................................................................................750i. Nasoethmoid, naso-orbital ethmoid, and skull base trauma..............................................753j. Bone grafting....................................................................................................................758

33. Cleft Lip and Cleft Palate Repair ...................................................................................................763a. Unilateral cleft lip repair ...................................................................................................765b. Bilateral cleft lip repair .....................................................................................................770c. Unilateral lip adhesion......................................................................................................775d. Bilateral lip adhesion ........................................................................................................778e. V to Y pushback palatoplasty............................................................................................782f. Two-flap palatoplasty........................................................................................................785g. Double reversing Z-plasty (Furlow palatoplasty)...............................................................788

34. Craniosynostosis ............................................................................................................................791a. Unilateral coronal craniosynostosis ...................................................................................794b. Bicoronal craniosynostosis ................................................................................................796c. Metopic craniosynostosis ..................................................................................................798d. Sagittal craniosynostosis....................................................................................................800e. Lambdoidal craniosynostosis ............................................................................................802

PATIENT EDUCATION AND ANESTHESIA

35. Information for Parents and Caregivers .........................................................................................807

36. Pediatric Anesthesia .......................................................................................................................823

Index....................................................................................................................................................829

Surgical Atlas of Pediatric OtolaryngologyCopyrightPrefaceContributorsContentsOTOLOGIC SURGERYCh01: Tympanostomy Tubes and Related ProceduresCh02: Approaches to the Middle Ear and MastoidCh03: Myringoplasty and TympanoplastyCh04: OssiculoplastyCh05: Mastoidectomy and CholesteatomaCh06: Perilymphatic Fistula and Eustachian Tube SurgeryCh07: Facial Nerve Exploration and RepairCh08: Ear Canal Stenosis and AtresiaCh09: Cochlear Implants

RHINOLOGIC SURGERYCh10: EpistaxisCh11: Nasal and Septal DeformitiesCh12: Congenital Nasal MalformationsCh13: Endoscopic Ethmoidectomy and AntrostomyCh14: Inflammatory Sinonasal DiseaseCh15: Sphenoid Sinus Surgery

ORAL AND PHARYNGEAL SURGERYCh16: Surgery of the TongueCh17: Tonsillectomy, Adenoidectomy, and UPPPCh18: Velopharyngeal InsufficiencyCh19: Surgery for Drooling

HEAD AND NECK SURGERYCh20: Cervical AdenopathyCh21: Deep Neck InfectionsCh22: Congenital Malformations of the NeckCh23: Salivary Gland SurgeryCh24: Thyroidectomy

ENDOSCOPY AND AIRWAY SURGERYCh25: Endoscopy of the Upper Aerodigestive TractCh26: TracheotomyCh27: Surgery of the Larynx and TracheaCh28: Laryngotracheal Laser Surgery

PLASTIC AND RECONSTRUCTIVE SURGERYCh29: Soft Tissue SurgeryCh30: Auricular Repair for MicrotiaCh31: Otoplasty for the Prominent EarCh32: Maxillofacial TraumaCh33: Cleft Lip and Cleft Palate RepairCh34: Craniosynostosis

PATIENT EDUCATION AND ANESTHESIACh35: Information for Parents and CaregiversCh36: Pediatric Anesthesia

IndexExit

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