Læknablaðið : fylgirit - 01.06.2005, Blaðsíða 24

ABSTRACTS / XXIX CONGRESS OF THE NORDIC ASSOCIATION OF OTOLARYNGOLOGY
activity. We compared the effects of Ocimum basilicum and
essential oil components (thymol, carvacrol and salicylaldehyde)
to placebo, placed in the ear canal of rats with experimental
otitis media caused by pneumococci or Haemophilus influenzae.
The progress was monitored by otomicroscopy and middle ear
cultures. The treatment cured 56-81% of the rats infected with H.
influenzae and 6-75% infected with pneumococci as opposed to
5.6-6% for the placebo group.
Essential oils or their components placed in the ear canal can
provide effective treatment of acute otitis media. If toxicity studies
confirm the safety of microbicidal essential oil components for the
ear, a significant advance can be made in the treatment of acute
otitis media.
Abstract no.: 046
Primary Stapes Surgery ‘A Personal Learning Curve’
Oates J, FRCS, Consultant Otologist, Queen’s Hospital, Burton on Trent
and Birmingham Heartlands Hospital, UK
The presentation will focus on the vein grafting technique for sta-
pes surgery. Appropriate surgical instrumentation, use of the KTP
or Argon laser probe and technical considerations will be discussed.
It will describe the step by step technique to confirm the diagnosis
and perform safe and efficient stapes surgery for Otosclerosis.
Simple but essential practical tips and tricks employed to maximise
results, which can be applied elsewhere in ossicular surgery, will be
described reinforced by illustration with multimedia presentation
using a combination of high resolution photos and video. Personal
experience will be detailed with particular emphasis on the ‘learn-
ing curve’, failures and lessons learned.
S-X THE SURGERY OF LARYNX
Abstract no.: 047
Use of C02 laser acublade for endoscopic microsurgery of
pharyngo-laryngeal benign lesions
Remacle M, Department of ORL - Head & Neck surgery, University
hospital of Louvain at Mont-Godinne. Belgium
From its inception, C02 laser was created for surgery. C02 laser
is still the surgical workhorse when tissue incision or vaporization
with minimum concomitant collateral damage is required.
Scanner applications now range from vaporization to incision.
By means of a computer-guided system of rotating mirrors,
the scanner allows the beam to sweep a given surface with
extreme rapidity. This feature makes it a very effective tool when
macroscopic vaporization is required. A ‘shaving’ effect a few
microns deep is achieved during each beam sweep with very little
in-depth thermal penetration.
The Acublade® is a scanner software modification that
allows the beam to travel across the target as a straight or curved
incision line instead of ‘shaving’ a given surface. Various lengths
(range: 0.5-3.5mm) and penetration depths (range: 0.2-2mm)
are programmable. The operator can, at all times, modify the
parameters proposed by the laser.
Because the sweeping speed was constant, the energy distribution
was uniform along the entire length of the line. This ensured a more
even incision and an improved hemostasis in comparison with the
results achieved using the manually guided beam.
Microscopic examination of the incision edges revealed that
the Acublade® causes less charring than a manually guided
beam. The coagulation thickness at the resection margin is clearly
smaller than that obtained with the Acuspot® alone. This finding
was observed with the phonomicrosurgical procedures, where
coagulation thickness averaged 50p.
The Acublade® reduces the operating time, at least for
relatively long procedures in continuous mode and where laser
is practically the sole instrument employed. It is more difficult
to demonstrate the time gain for phonomicrosurgery where
operative maneuvers (such as exploration and palpation) and
intraoperative inspection of the surgical steps represent most of
the time spent.
We did not observe any Acublade®-induced intraoperative or
postoperative complication.
Abstract no.: 048
Pitfalls in medialization thyroplasty
Hans Mahieu, Amsterdam, The Netherlands
Laryngeal Framework Surgery (LFS) is functional surgery per
definition, aimed at improvement of voice. It should therefore be
performed under local anaesthesia, enabling monitoring of the
voice as well as endoscopic evaluation of vocal fold position dur-
ing phonation.
The most common cause of failure is inadequate monitoring
or misinterpretation of the monitored parameters. Most often
under-correction occurs, either because of reluctance to perform
additional arytenoid adduction, or because of failed recognition
of a sub-optimal position of the contra-lateral vocal fold, requiring
contra-lateral medialization thyroplasty.
When in doubt concerning undercorrection: perform
additional arytenoid adduction. The combination of medialization
thyroplasty and arytenoid adduction is most effective to correct
larger glottic gaps. Also the possibility of correction of vocal fold
tension, e.g. by means of additional crico-thyroid approximation
is often neglected.
The second most common cause of failure is inadequate design
of the cartilage window in medialization thyroplasty. Especially
posteriorly there may be a tendency for too high design of the
window, medializing the ventricular fold in stead of the vocal
fold. In a posteriorly too low designed window is medialization
is restricted by the cricoid cartilage. Both situations can be
recognized endoscopically as failing medialization of the vocal
fold.
The third most common cause of failure is anterior dislocation
or over-correction of the cartilage window, which is recognized by
a strained and pressed phonation and anterior bulging of the vocal
fold. This can be corrected by attaching a suture to the anterior
part of the cartilage window for anterior fixation in the correct
position.
Severe complication are rare, but airway obstruction
24 Læknablaðið/Fylgirit 51 2005/91