Prospective Evaluation of Office-Based Injection Laryngoplasty with Hyaluronic Acid Gel

Objectives:

The role of Juvederm Ultra Plus hyaluronic acid gel for use in injection laryngoplasty has not been well examined. The aim of this study was to prospectively assess the safety and clinical effectiveness of office-based injection laryngoplasty of Juvederm Ultra Plus gel in patients with glottic insufficiency.

Methods:

Thirty patients met the criteria for study inclusion and were treated with unsedated office-based injection laryngoplasty of Juvederm Ultra Plus gel over a 20-month period. The preinjection acoustic and aerodynamic measures, Voice Handicap Index, Glottal Function Index, and Dysphonia Severity Index were compared with values recorded at 1 and 4 months after injection.

Results:

Data for 27 patients were available for follow-up analysis at 1 month, and 12 patients' data were available at 4 months. Significant improvements, compared to preinjection levels (p < 0.02), were shown in all outcome measures at 1 and 4 months. One patient required intravenous steroid therapy for delayed glottic inflammation that resolved without permanent sequelae.

Conclusions:

The injection of Juvederm Ultra Plus gel is a relatively safe procedure that allows for short-term improvements in objective and subjective outcome measures of vocal function in patients with glottic insufficiency, provided the surgeon remains alert to the possibility of postprocedural injection site inflammation.

Chronic rhinosinusitis with nasal polyps: a proteomic analysis

OBJECTIVES

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a severe subtype of chronic rhinosinusitis that can affect patients despite medical and surgical interventions. The purpose of this study was to utilize the techniques of proteomics to investigate differences in protein abundance within the sinonasal mucosa of patients with CRSwNP compared to healthy controls.

METHODS

In a case-control study at a tertiary-care academic medical center, sinonasal mucosa was harvested from 3 patients with CRSwNP and 3 control patients undergoing transsphenoidal excision of pituitary tumors. Two-dimensional gel electrophoresis was used to identify proteins with elevated or reduced abundance in CRSwNP patients compared to controls. The proteins showing the greatest abundance differences were characterized by mass spectrometry.

RESULTS

More than 300 differentially abundant proteins (p < or = 0.05) were identified. Many of these protein species were involved in the host inflammatory response. Proteins up-regulated in CRSwNP patients included eosinophil lysophospholipase by a ratio (R) of 18.13, RHO-GDP dissociation inhibitor 2 (R = 2.80), and apolipoprotein A-1 (R = 1.73). Down-regulated proteins in CRSwNP patients included catalase (R = -5.87), annexin A1 (R = -6.27), and keratin II-8 (R = -6.73). A detailed analysis of additional protein species is outlined.

CONCLUSIONS

The proteomic approach allows detection of significant differences in protein abundance in CRSwNP and provides unique insight into the pathophysiology of this common disease.

Parotidectomy: ten-year review of 237 cases at a single institution

OBJECTIVE

To review a single surgeon's experience with parotidectomy with an emphasis on examining the appropriate use of partial superficial parotidectomy and the differences in early outcomes observed with the various types and extent of parotidectomy used.

STUDY DESIGN AND SETTING

A series of 237 patients who underwent parotidectomy over a 10-year period was reviewed.

RESULTS

Postoperative complications included facial nerve weakness (18%), sialocele (6.3%), wound infection (3.8%), hematoma (3.8%), and symptomatic Frey's syndrome (1.7%). More extensive surgical procedures, including complete superficial or total parotidectomy, were associated with a 2.7 times greater incidence of immediate postoperative facial nerve weakness compared with partial superficial parotidectomy.

CONCLUSION

Partial superficial parotidectomy is associated with a decreased incidence of transient postoperative facial nerve weakness compared with more extensive procedures such as complete superficial or total parotidectomy. Intraoperative frozen section was an accurate means of selecting patients for the partial superficial parotidectomy procedure.

SIGNIFICANCE

Partial superficial parotidectomy is an effective method for treating benign tumors confined to the superficial lobe.