Phẫu Thuật Tai Mũi Họng Và Phẫu Thuật Đầu Cổ

1400
Section 15
Temporal Bone
transverse crest separates the superior vestibular nerve
from the inferior vestibular nerve.
Dura along the posterior aspect of the internal
auditory canal is incised, and superior and inferior
dural fl aps are developed to expose the contents of the
internal auditory canal (Fig. 131-15). The superior ves-
tibular nerve is then separated from the facial nerve
from a lateral to medial direction using a blunt dissec-
tor. A 3- to 5-mm length of the superior vestibular nerve
is resected. Similarly, the inferior vestibular nerve is
separated from the cochlear nerve anteriorly by gentle
blunt dissection from a medial to lateral direction to
minimize traction on the cochlear nerve. A short
segment of the inferior vestibular nerve is also resected
(Fig. 131-16). The singular nerve is specifi cally identi-
fi ed and divided.
Once the nerve section is complete, the dura of the
internal auditory canal is reopposed. In a well-aerated
temporal bone with a large aditus ad antrum, the incus
should be removed so that the eustachian tube and
middle ear can be packed with temporalis muscle. The
mastoid cavity is obliterated with free abdominal
fat grafts. A watertight multilayer closure is then
completed using a combination of absorbable and
nonabsorbable sutures. A compressive mastoid dressing
is applied for 3 days. The patient is discharged home
on postoperative day 4 if no cerebrospinal fl uid leak is
apparent.
Posterior Fossa Approaches for Vestibular
Nerve Section
The vestibular nerve may be exposed within the
posterior fossa with an approach through the mastoid
(retrolabyrinthine/presigmoid) or through a retromas-
toid/retrosigmoid craniotomy (retrosigmoid approach).
Both approaches preserve hearing in the operated
ear.
The posterior fossa approaches for vestibular nerve
section are popular because they provide consistent
and direct exposure of the cerebellopontine angle
and expose the cochleovestibular and facial nerves
between the porus of the internal auditory canal and
the brain stem. Using these approaches, the facial nerve
is easily identifi ed anterior to the cochleovestibular
nerve, and inadvertent injury to the facial nerve is
uncommon.
The primary disadvantage of these approaches is
that the vestibular nerve is exposed where the vestibular
portion of the cochleovestibular nerve is not anatomi-
cally separate from the cochlear portion. Thus, location
and division of the vestibular nerve must be based on
the surgeon’s knowledge of the anatomy of the cochleo-
vestibular nerve. The presence of small blood vessels,
which tend to demarcate the cochlear and vestibular
nerve fi bers, and subtle color differences between the
two types of nerve fi bers aid the surgeon in determining
the plane between the vestibular versus cochlear nerve.
Although there is a possibility of leaving some vestibular
fi bers uncut, the high rates reported for the control of
vertigo suggest that leaving a few vestibular fi bers uncut
may be of limited clinical signifi cance.
Retrolabyrinthine Approach for Vestibular
Nerve Section
The patient is positioned supine with the head turned
away from the surgeon. The ear is prepped and draped
as for standard neuro-otologic surgery. Intraoperative
facial nerve and evoked auditory brain stem responses
are monitored routinely. A single dose of antibiotic is
administered at the time of induction of general
anesthesia. A wide C-shaped incision is made approxi-
mately 3 cm posterior to the postauricular crease and
extended down to the temporalis fascia superiorly and
mastoid periosteum inferiorly. Skin and subcutaneous
tissue are then elevated in the subcutaneous plane ante-
riorly. The temporalis muscle and fascia and the peri-
osteum are incised with an offset incision to allow for a
good layered wound closure at the end of the proce-
Figure 131-15. The transverse crest and Bill’s bar are exposed at
the fundus of the internal auditory canal. The dura of the internal
auditory canal is opened. The facial, superior vestibular, inferior ves-
tibular, and singular nerves are identifi ed.
Figure 131-16. A segment of the vestibular nerve is resected.
Facial
nerve
Cochlear
nerve
Superior
vestibular
nerve
Inferior
vestibular
nerve
Inferior
vestibular
nerve
Vertical
crest
(Bill’s bar)
Transverse
crest
Singular
nerve
Superior
vestibular
nerve
Facial
nerve

Chapter 131
Surgery for Vertigo 1401
dure to prevent or contain cerebrospinal fl uid leaks
through the incision. An anteriorly based musculoperi-
osteal fl ap is then elevated to expose the mastoid cortex
and secured in place with a large self-retaining
retractor.
A complete mastoidectomy is performed and expo-
sure down to the mastoid antrum allows for identifi ca-
tion of the LSC. Bone overlying the middle fossa dura,
sigmoid sinus, and posterior fossa dura is carefully
removed using a large diamond burr. The vestibular
labyrinth is exposed; particular attention is directed to
fully skeletonizing the posterior semicircular canal (Fig.
131-17). Gelfoam is used to block the aditus ad antrum.
The remaining bone over the posterior fossa dura
between the sigmoid sinus and PSC is then removed
with a Freer elevator or similar blunt dissector (Fig.
131-18). The endolymphatic sac and duct are preserved.
The mastoid cavity is thoroughly irrigated with Bacitra-
cin solution (Bacitracin 50,000 units/L of saline) once
all bone dissection has been completed.
The dura anterior to the sigmoid is incised, creat-
ing an anteriorly based C- or U-shaped dural fl ap (Fig.
131-19). A 1/2- × 3-cm neurosurgical cottonoid patty is
placed over the cerebellum (Fig. 131-20). Cerebrospi-
nal fl uid is drained from the cerebellopontine cistern
by opening the arachnoid in this location. The cerebel-
lum falls away, allowing visualization of cranial nerves
(CN) VII and VIII, centered within the fi eld, with CN
V anteromedially and CN IX, X, and XI laterally and
inferiorly (Fig. 131-21).
Under high magnifi cation, the courses of CN VII
and CN VIII are examined and confi rmed using electri-
cal stimulation of CN VII (Fig. 131-22). Any small vessels
intimately associated with CN VIII are gently dissected
Figure 131-17. The mastoidectomy is completed by skeletonizing
the semicircular canals and the bony plate overlying the posterior
fossa dura.
Figure 131-18. Dura overlying the posterior fossa and sigmoid
sinus is exposed.
Figure 131-19. An anteriorly based U-shaped dural fl ap is devel-
oped, and the contents of the posterior fossa are exposed.
off the nerve. A surgical plane is then developed between
the cochlear and vestibular portions of CN VIII. A
recent cadaver study found that in an average of 75%
of cases, the surgeon could visually identify a cleavage
plane within the vestibulocochlear nerve near the porus
acusticus, or develop it near that point with a ball-tipped
dissector.21 The vestibular division of CN VIII typically
appears grayer than the cochlear division, which appears
whiter. Often a minute blood vessel lies along this cleav-
age plane (Fig. 131-23). The vestibulocochlear nerve
also rotates approximately 90 degrees as it passes from

1402
Section 15
Temporal Bone
the vestibular division of the eighth nerve starting from
the superior-dorsal surface of the nerve (Fig. 131-25).
The nervus intermedius commonly adheres to the
ventral surface of the eighth nerve near the junction of
the vestibular and cochlear divisions. The nervus inter-
medius is identifi ed by its whiter appearance and can
be traced back to the brain stem coursing between the
seventh and eighth cranial nerves. Electrical stimula-
tion of the nervus intermedius will excite the facial
nerve but at a higher threshold than will direct stimula-
Figure 131-20. A 1/2- × 3-cm neurosurgical cottonoid patty is
advanced between the anterior edge of the dura and the surface of
the cerebellum.
Figure 131-21. Retrolabyrinthine exposure of the posterior fossa.
Figure 131-22. Anatomic relationships of the vestibular nerve,
cochlear nerve, and facial nerve.
the lateral internal auditory canal back toward the
porus and brain stem, in a counterclockwise direction
on the right side as viewed from the medial porus, and
correspondingly clockwise on the left side.22 Near the
brain stem, the vestibular portion of CN VIII is usually
more superior (closer to the tentorium); near the
porus, it is usually superior or dorsal.
If a clear plane of demarcation can be identifi ed, a
no. 1 Roton dissector is used to separate the cochlear
and vestibular divisions along this plane (Fig. 131-24).
A bayoneted curved microscissors is then used to cut
Figure 131-23. A perineural plane between the cochlear and ves-
tibular nerves is frequently demonstrated by a small vessel or a slight
depression in the nerve running longitudinally on the dorsal surface
of the nerve.
Perineural plane
between cochlear
and vestibular nerves
Facial nerve
Cochlear nerve
Vestibular nerve
Facial nerve
Cochlear nerve
Vestibular nerve
7th cranial nerve
9th, 10th, and
11th cranial
nerves
5th cranial
nerve
8th cranial
nerve

Chapter 131
Surgery for Vertigo 1403
tion of the facial nerve. To complete sectioning of the
vestibular division, the eighth nerve is sectioned to the
level of the nervus intermedius. The surgeon completes
the neurectomy with removal of a 5- to 10-mm segment
of nerve (Fig. 131-26).
If the plane of demarcation is not clear, the vestibu-
lar division probably has rotated from a superior to a
more dorsal relationship to the cochlear division (Fig.
131-27). In this situation, a bayoneted, curved micro-
scissors is used to begin the nerve section starting from
the superior-dorsal margin of the nerve. A no. 3 Roton
dissector is then used to dissect the cut fi bers toward
the brain stem. Additional fi bers are then divided with
microscissors and dissected medially. This technique is
continued until the cochlear division and nervus inter-
medius are identifi ed by color changes and perineural
tissue planes appear.
After completion of the neurectomy, the neuro-
surgical patty is removed and hemostasis is secured.
Dura is reapproximated with interrupted 4-0 Surgilon.
Postoperative cerebrospinal fl uid leak is prevented by
packing the aditus ad antrum with a temporalis muscle
graft and the mastoid cavity with free abdominal fat
grafts. Layered wound closure is accomplished in the
standard fashion, with additional skin closure using 4-0
nylon. A compressive mastoid dressing is then applied
for 72 hours.
Figure 131-24. Separation of the cochlear and vestibular nerves.
Figure 131-25. The vestibular nerve is divided starting from the
superior-dorsal surface of the eighth cranial nerve.
Figure 131-26. The completed vestibular nerve section.
Figure 131-27. If a clear plane is not observed between the vestibu-
lar and cochlear nerves, the vestibular nerve is usually dorsal to the
cochlear nerve.
Cochlear nerve
Facial nerve
Vestibular
nerve

1404
Section 15
Temporal Bone
Retrosigmoid Approach for Vestibular
Nerve Section
For a retrosigmoid vestibular nerve section, the patient
is placed in a supine position, and a Mayfi eld head
holder and pins are used to secure the head. A soft roll
is placed under the ipsilateral shoulder, and the head
is positioned in a 45-degree contralateral rotation and
slight downward inclination. The bed is further rotated
away to the contralateral side to optimize the angle of
exposure of the posterior fossa (Fig. 131-28).
Intraoperative facial nerve and evoked brain stem
audiometry monitoring is always used. Perioperative
antibiotics are used for 24 hours, and dexamethasone
(Decadron 10 mg) is given at the time of surgery. The
anesthetist is instructed to keep the patient’s PCO2 below
30 mm Hg and to infuse 0.3 to 0.5 g/kg of mannitol at
the beginning of the case to lower intracranial
pressure.
An oblique linear skin incision is made approxi-
mately 4 cm behind the mastoid tip and angled anteri-
orly and superiorly for 5 cm (Fig. 131-29). Typically, the
epidermis is incised with a knife, and cutting cautery is
used to divide the dermis and subcutaneous tissues. The
subcutaneous dissection is carried fi rst posteriorly then
medially down to the bony cranium. The subcutaneous
tissues and deep musculature overlying the retromas-
toid cranium are elevated forward via a combination of
blunt dissection and electrocautery. The mastoid emis-
sary vein is isolated and divided, and the bony foramen
of the vein is occluded with bone wax. The dissection
is carried inferiorly until the cranium curves medially
near the margin of the foramen magnum. Anteriorly,
the posterior insertions of the digastric muscle are
released, and superiorly the inferior margin of the tem-
poralis muscle is exposed. Self-retaining retractors are
positioned and hemostasis secured.
The courses of the sigmoid and transverse sinuses
are estimated by examining the surface anatomy of
the mastoid and retromastoid cranium (Fig. 131-30). A
high-speed cutting burr is used to outline the posterior
margin of the sigmoid sinus and inferior margin of the
transverse sinus under magnifi cation. A retrosigmoid
craniotomy measuring approximately 2.5 × 2.5 cm (Fig.
131-31) is performed using a combination of high-speed
drills and rongeurs. Before opening the dura, hemosta-
sis is secured and all exposed mastoid air cells are
occluded with bone wax. The dura is incised in a manner
creating an anteriorly based U-shaped dural fl ap (Fig.
131-32). Bipolar electrocautery is used for hemostasis.
Surgilon 4-0 sutures are placed through the dural fl ap
and used to retract the fl ap anteriorly.
Exposure of the posterior fossa contents, and iden-
tifi cation of and section of the vestibular nerve are then
completed in the manner described for the retrolaby-
rinthine approach. The dura is then closed with 4-0
Surgilon sutures. Small pieces of free abdominal fat
graft are placed over the dura in the craniotomy site.
The craniotomy is reconstructed by securing the
Figure 131-28. Positioning of the patient for a retrosigmoid ves-
tibular nerve section.
Figure 131-29. The skin incision for a retrosigmoid vestibular
nerve section.
Figure 131-30. The surface anatomy of the mastoid and retrosig-
moid cranium, and the estimated course of the transverse and sigmoid
sinuses.
Lambdoid
suture
Transverse
sinus
Occipitomastoid
suture
Sigmoid
sinus
Mastoid tip
Squamosal
suture
Asterion

Chapter 131
Surgery for Vertigo 1405
craniotomy fl ap in place using surgical plates or mesh.
The incision is then closed in three layers with a deep
layer of 2-0 Vicryl reapproximating the musculoperios-
teal tissue over the cranium. The deep cutaneous tissues
are closed with 2-0 Vicryl. The skin incision is closed
with a running 4-0 nylon stitch, and a light dressing is
applied for 24 hours.
Middle Fossa Approach for Vestibular
Nerve Section
When hearing is present and the patient suffers from
persistent vertigo after a retrolabyrinthine vestibular
neurectomy, a middle fossa nerve section may be indi-
cated to divide the vestibular components of CN VIII
more distally and maintain hearing in the operated ear.
This procedure is rarely used as the primary approach
for vestibular nerve section. The advantage of this
approach is that it enables visualization of the vestibular
nerve where the superior, inferior, and singular nerves
have separated from the cochleovestibular trunk, thus
increasing the likelihood of a complete nerve section.
This approach is more technically demanding and of
necessity involves some retraction of the temporal lobe
for an extended period. The risk of facial nerve injury
and SNHL is greater than that incurred using the pos-
terior fossa approaches.
The patient is positioned supine with the head
turned to the contralateral side so that the operated ear
faces up. Intraoperative facial nerve and brain stem
evoked audiometry responses are monitored routinely.
Broad-spectrum antibiotics are administered intrave-
nously at induction of general anesthesia. Diuretics and
steroids are also used to reduce cerebrospinal fl uid
pressure. An incision is made in the preauricular crease,
starting at the level of the lower border of the zygoma
and extending superiorly above, behind the auricle to
form a reverse-question mark (Fig. 131-33). Anterior
and posterior skin fl aps lateral to the temporalis fascia
are elevated to expose the temporalis muscle. An
anteroinferiorly based temporalis muscle fl ap is created
by incising the muscle along the linea temporalis using
Bovie electrocautery. A 5- × 5-cm craniotomy, centered
two-thirds anterior and one-third posterior to the exter-
nal auditory canal, and inferiorly based at the root of
the zygoma is created using a 4-mm cutting burr (Fig.
131-34). The bone fl ap is carefully elevated from under-
lying dura using a dural elevator and soaked in Bacitra-
cin solution until the end of the case. Any bleeding
from the dura may be controlled with bipolar electro-
cautery. The inferior border of the craniotomy is then
lowered to the level of the middle fossa fl oor. Dura is
Figure 131-31. The retrosigmoid craniotomy bordered by the
sigmoid and transverse sinuses.
Figure 131-32. Creation of an anteriorly based dural fl ap with
gentle pressure applied on the lateral surface of the cerebellum.
Figure 131-33. Skin incision for a middle fossa craniotomy.
Sigmoid sinus
Transverse
sinus

1406
Section 15
Temporal Bone
carefully elevated off the middle fossa fl oor in a poste-
rior to anterior direction to expose the anatomy of the
fl oor of the middle fossa (Fig. 131-35). The limits of
exposure are the middle meningeal artery anteriorly,
the sulcus of the superior petrosal sinus medially, and
the arcuate eminence overlying the dome of the supe-
rior semicircular canal posteriorly. Dura over the greater
superior petrosal nerve (GSPN) tends to be densely
adherent to the nerve. Therefore, great care is needed
in dissection at this point due to the possibility of a
dehiscent geniculate ganglion. The dura is elevated in
a posterior to anterior direction to minimize injury to
the GSPN and geniculate ganglion. Once exposure of
the middle fossa fl oor is complete, the tongue of the
middle fossa self-retaining retractor is secured at the
sulcus of the superior petrosal sinus to retract the tem-
poral lobe.
The fl oor of the middle fossa is then inspected.
Anatomic landmarks to be identifi ed include the GSPN,
the geniculate ganglion, and the arcuate eminence
overlying the dome of the superior semicircular canal.
The location of the internal auditory canal is deter-
mined by bisecting the angle formed by the GSPN and
arcuate eminence (Fig. 131-36). The roof of the inter-
nal auditory canal is fi rst skeletonized over the medial
half of the canal. Once the canal has been defi nitively
identifi ed, it may be followed out laterally to the fundus
using progressively smaller diamond burrs. At the
fundus of the internal auditory canal, the proximity of
the basal turn of the cochlea and the ampulla of the
SSC limit bony exposure to a 90-degree circumference
over the roof of the canal (Fig. 131-37). Bill’s bar at the
Figure 131-34. Middle fossa craniotomy.
Figure 131-35. Anatomy of the middle fossa fl oor. GSPN, Greater
superfi cial petrosal nerve.
Figure 131-36. Locating the internal auditory canal. GSPN,
Greater superfi cial petrosal nerve.
Figure 131-37. Exposure of the internal auditory canal. GSPN,
Greater superfi cial petrosal nerve.
Geniculate
ganglion
Geniculate
ganglion
Arcuate
eminence
Arcuate
eminence
GSPN
Internal
auditory
canal
GSPN
Arcuate
eminence
Vestibular
nerve
Cochlear
nerve
Facial
nerve
Cochlear
nerve
GSPN
Facial
nerve
Middle
meningeal
artery

Chapter 131
Surgery for Vertigo 1407
lateral end of the internal auditory canal separates the
facial nerve anteriorly from the superior vestibular
nerve posteriorly.
Once the dura of the internal auditory canal is
exposed, it is incised along the posterior one half of the
internal auditory canal (Fig. 131-38). The contents of
the canal are identifi ed and the facial nerve course is
confi rmed using electrical stimulation. Vestibulofacial
anastomotic fi bers are divided (Fig. 131-39). The supe-
rior vestibular nerve is divided laterally and retracted
medially to expose the inferior vestibular nerve (Fig.
131-40). The inferior vestibular nerve and the singular
nerve are divided (Fig. 131-41). Finally, a segment of
nerve containing Scarpa’s ganglion is removed with
microscissors. Care must be taken not to disrupt any
blood vessels in the distal internal auditory canal, or
else profound SNHL and facial paralysis can occur.
Once the nerve section is complete, the dural fl aps
are reopposed and the roof of the internal auditory
canal is plugged with a free fat or muscle graft. The
temporal lobe is allowed to reexpand over the middle
fossa fl oor. The craniotomy bone plate is replaced. The
surgical site is closed in layers to achieve a watertight
seal. A light mastoid dressing is placed over the oper-
ated ear and kept in place for 24 to 72 hours. The
patient is observed in the hospital for 3 to 4 days. Peri-
operative antibiotics are administered for 24 hours.
Repair of Superior Semicircular Canal
Dehiscence Syndrome
Surgical repair of a symptomatic dehiscent SSC is per-
formed using a middle fossa approach, as described
Figure 131-38. The dura of the internal auditory canal is incised.
Figure 131-39. Vestibulofacial anastomotic fi bers are divided.
Figure 131-40. The superior vestibular nerve is divided distally.
Figure 131-41. The inferior vestibular nerve and the singular
nerve are divided distally.
Superior vestibular
nerve
Singular nerve
Inferior
vestibular
nerve
Superior
vestibular
nerve

1408
Section 15
Temporal Bone
above for middle fossa vestibular nerve section. Once
the middle fossa fl oor is exposed and the self-retaining
middle fossa retractor placed under the bony petrous
ridge, the arcuate eminence is identifi ed. The arcuate
eminence corresponds to the SSC in most cases. The
dehiscent segment of the SSC is identifi ed and
inspected.
We have adopted the practice of both plugging and
capping the SSC in each case. A bone paste is made
from bone dust from the craniotomy and bone wax,
and compressed into the defect to occlude the mem-
branous labyrinth. A split-thickness calvarial bone graft
is then fashioned from the middle fossa craniotomy
bone fl ap and placed over the bony defect in the fl oor
of the middle fossa. Any defects laterally along the
tegmen should also be either occluded with bone wax
or covered with fascia. The temporal lobe is allowed to
reexpand over the middle fossa fl oor after removal of
the self-retaining retractor. The craniotomy fl ap is
replaced, and temporalis muscle and skin incision are
closed in multiple layers to achieve a watertight seal. A
light mastoid dressing is placed over the operated ear
and kept in place for 24 to 72 hours. The patient is
observed in the hospital for 3 to 4 days. Perioperative
antibiotics are administered for 24 hours.
POSTOPERATIVE MANAGEMENT
Most surgical procedures for vertigo will result in varying
degrees of postoperative disequilibrium. Vestibular
rehabilitation and physical therapy should be instituted
early if symptoms are moderate to severe. Additional
supportive care during this time includes antiemetic
medications, pain control, and intravenous fl uids.
Nonablative procedures such as endolymphatic sac
surgery and PSCO may also result in mild postoperative
disequilibrium necessitating overnight observation in
the hospital.
All patients undergoing intracranial surgery should
receive broad-spectrum antibiotics intravenously for 24
hours. These patients are closely monitored in the post-
operative period for potential complications including
cerebrospinal fl uid leak, meningitis, and intracranial
bleeding.
COMPLICATIONS
Complications specifi c to surgery for vertigo include
cerebrospinal fl uid leak, meningitis, facial nerve injury,
and further hearing loss. Management of postoperative
cerebrospinal fl uid leaks and iatrogenic facial nerve
injuries are discussed elsewhere in this text. Potential
risks and complications of each surgical procedure
should be discussed with patients during the process of
obtaining informed consent for surgery.
Posterior Semicircular Canal Occlusion
SNHL may occur if the vestibule is violated during skel-
etonization of the PSC. This usually occurs if the PSC
is fenestrated too close to its ampulla, rather than
midway between the ampulla and the common crus.
Suctioning should be avoided in and around the fenes-
trated PSC because this may disrupt the membranous
labyrinth. Temporary SNHL may result from a serous
labyrinthitis. Postoperative SNHL, dizziness, and vertigo
may be reduced by minimizing the size of the PSC fen-
estration and administering perioperative steroids.
Endolymphatic Sac Surgery
Risks specifi c to this procedure include hearing loss,
facial nerve injury, inadvertent fenestration of the PSC,
bleeding resulting from trauma to the sigmoid sinus,
and cerebrospinal fl uid leak resulting from a dural tear.
If the PSC is inadvertently fenestrated, the surgeon
should avoid suctioning near the membranous laby-
rinth and immediately plug the defect with bone wax.
The facial nerve is at risk for injury in the mastoid
segment when skeletonizing the PSC and opening ret-
rofacial air cells. Hearing loss resulting from endolym-
phatic sac surgery may be conductive or sensorineural
in nature. Conductive hearing loss usually occurs as a
result of blood in the middle ear after surgery. Delayed
conductive hearing loss may occur if trapped bone dust
in the middle ear causes bony ankylosis of the ossicular
chain. This is prevented by plugging the aditus ad
antrum with Gelfoam during the procedure. The pos-
terior fossa dura may be violated when thinning the
overlying bone at the time of initial exposure. Addition-
ally, if the endolymphatic sac is not clearly identifi ed,
the posterior fossa dura may be mistakenly incised,
resulting in cerebrospinal fl uid leak. If the dural defect
is small, it may be plugged with a small piece of muscle
sutured in place with 4-0 Surgilon. A larger dural defect
should be repaired with autologous tissue, and the
middle ear and mastoid should be obliterated with
muscle and fat, respectively, to prevent postoperative
cerebrospinal fl uid leak. Antibiotics are administered if
a leak is detected at the time of surgery.
Labyrinthectomy
Facial nerve injury and cerebrospinal fl uid leak may
occur during a labyrinthectomy. Knowledge of the
normal intratemporal course of the facial nerve is criti-
cal in avoiding iatrogenic trauma to the nerve. When
the LSC is fenestrated, the inferior wall of the canal
should be preserved to protect the second genu of
the facial nerve. The ampulla of the PSC is found
deep to and under the facial nerve. Drilling should
proceed cautiously in this area to expose the neuroepi-
thelial contents of the ampulla without violating the
facial nerve. The labyrinthine facial nerve is protected
by preserving the medial wall of the SSC and LSC
ampullae.
Cerebrospinal fl uid leak may occur if the lateral
portion of the internal auditory canal is inadvertently
opened at the level of the vestibule or if the dura of the
posterior or middle fossa are violated. Cerebrospinal
fl uid leak can be avoided by preserving the medial wall
of the vestibule. In addition, the neurosensory epithe-
lium of the inner ear must be removed carefully, or the
underlying bony cribrosa that transmits the vestibular

Chapter 131
Surgery for Vertigo 1409
nerve axons can be disrupted, causing a cerebrospinal
fl uid leak. If a cerebrospinal fl uid leak occurs, the
remaining labyrinthine capsule and mastoid should be
obliterated with a free abdominal fat graft. Intravenous
antibiotics are started intraoperatively and continued
for 24 hours if a leak occurs.
Translabyrinthine Vestibular Nerve Section
Complications of translabyrinthine vestibular nerve
section include facial nerve injury and cerebrospinal
fl uid leak. The risk of facial nerve injury is greater for
translabyrinthine vestibular neurectomy than for laby-
rinthectomy because of the additional risk of facial
nerve injury in the internal auditory canal and proximal
labyrinthine segment. The facial nerve may be injured
during bony exposure of the proximal fallopian canal
and dissection of the nerve within the internal auditory
canal.
The anterior inferior cerebellar artery may loop
deep into the internal auditory canal and can be injured
during dissection of the contents of the canal. If bleed-
ing is encountered within the internal auditory canal,
the source of bleeding should be clearly identifi ed.
Electrocautery should not be generally used within the
internal auditory canal because spread of current may
injure the facial nerve or anterior inferior cerebellar
artery. In this situation, bleeding may be controlled
with Surgicel.
Retrolabyrinthine and Retrosigmoid
Vestibular Nerve Sections
Potential complications of both approaches include
bleeding from a dural sinus, cerebellar edema, facial
nerve injury, cochlear nerve injury, intracranial vascular
injury, postoperative headache, and cerebrospinal
fl uid leak.
Trauma to the dural sinuses is best avoided by use
of a gentle and patient technique when drilling near
the sinuses. Rongeurs are used only after the dura has
been freed from the overlying bone with dural eleva-
tors. The tip of the rongeur can easily tear a dural sinus
if the tip is extended past the area of dura that has been
elevated. A tear in the sigmoid sinus or mastoid emis-
sary vein is usually managed by covering the area with
Surgicel and applying light pressure. Larger tears may
need to be repaired with 4-0 silk, with or without the
addition of a small muscle plug.
Injury to the facial nerve is a rare but potential
complication because of its proximity to the eighth
nerve complex. Injury to the facial nerve is best avoided
by clear identifi cation of the nerve before the vestibular
nerve section is performed. Electrical stimulation of the
facial nerve is recommended to confi rm the location
and course of the nerve. Occasionally, the facial nerve
is adherent to the ventral surface of the eighth nerve
and will need to be separated from it before sectioning
of the vestibular nerve. The facial nerve should be elec-
trically stimulated at the end of the procedure to
confi rm its functional integrity. If the nerve does not
respond to electrical stimulation, anatomic continuity
should be confi rmed by direct visualization of the
course of the nerve. A transected nerve should be
repaired primarily.
Trauma to the cochlear nerve is best avoided by
using meticulous surgical technique. The arterial blood
supply to the nerve must be maintained. Bipolar cautery
near the eighth nerve should be used judiciously.
Headache in the immediate postoperative period
may occur from sterile arachnoiditis, elevated intracra-
nial pressure, or meningitis. To reduce the occurrence
of sterile arachnoiditis and elevated intracranial pres-
sure, one should use meticulous hemostasis. Dexameth-
asone is used perioperatively to reduce the severity of
early postoperative headache. Retrosigmoid cranioto-
mies should be reconstructed by replacing and securing
the bone fl ap to avoid the development of chronic
headaches. If headaches occur and persist, secondary
reconstruction of the craniotomy defect, sensory
nerve anesthetic block, or sensory nerve section may be
required.
Middle Fossa Vestibular Nerve Section
Additional complications encountered with the middle
fossa approach include SNHL, vertigo, facial paralysis,
intracranial bleeding, and cerebrospinal fl uid leak. A
thorough knowledge of temporal bone anatomy as visu-
alized from the middle fossa fl oor is helpful in avoiding
iatrogenic trauma to the facial nerve, cochlea, and ves-
tibular labyrinth.
Facial paralysis occurs more frequently with the
middle cranial approach than with any other approach
for vestibular nerve section. The facial nerve is primarily
at risk while one is exposing and working within the
internal auditory canal. The dura of the internal audi-
tory should be opened posteriorly, over the superior
vestibular nerve. The vestibulofacial anastomoses must
be sharply divided to avoid traction injury to the facial
nerve.
Temporal lobe edema, contusion, or subdural
hematoma may occur from direct injury during the
craniotomy or from retraction injury during elevation
of the dura overlying the middle cranial fossa. These
complications are avoided by taking steps to reduce
intracranial pressure at the start of surgery (i.e., reduc-
ing Pco2, intravenous mannitol, and dexamethasone).
If the temporal lobe is tight, a small incision in the dura
can be made to release cerebrospinal fl uid before
retraction of the temporal lobe. If temporal lobe injury
is suspected, a head CT scan should be performed post-
operatively to assess the degree of edema of the tempo-
ral lobe, and a neurosurgical colleague should be
consulted.
Superior Semicircular Canal
Dehiscence Repair
This procedure poses risks similar to those incurred
with middle fossa vestibular nerve section. Because the
surgeon is intentionally occluding the SSC, there is a
risk of SNHL as well, just as in the PSC occlusion
procedure.23

1410
Section 15
Temporal Bone
vestibular labyrinth in patients with atypical and intractable
benign positional vertigo. ORL J Otorhinolaryngol Relat Spec
63:165-177, 2001.
4. Schratzenstaller B, Wagner-Manslau C, Strasser G, et al: Intracta-
ble and atypical benign paroxysmal vertigo. Pathological results
of high-resolution three-dimensional MR-tomography of the ves-
tibular organ. HNO 53:1063-1066, 1068-1070, 1072-1063, 2005.
5. White J, Savvides P, Cherian N, et al: Canalith repositioning for
benign paroxysmal positional vertigo. Otol Neurotol 26:704-710,
2005.
6. Shaia WT, Zappia JJ, Bojrab DI, et al: Success of posterior semi-
circular canal occlusion and application of the dizziness handicap
inventory. Otolaryngol Head Neck Surg 134:424-430, 2006.
7. Dunniway HM, Welling DB: Intracranial tumors mimicking
benign paroxysmal positional vertigo. Otolaryngol Head Neck
Surg 118:429-436, 1998.
8. Minor LB, Schessel DA, Carey JP: Ménière’s disease. Curr Opin
Neurol 17:8-16, 2004.
9. Thomsen J, Bretlau P, Tos M, et al: Placebo effect in surgery for
Ménière’s disease. A double-blind, placebo-controlled study on
endolymphatic sac shunt surgery. Arch Otolaryngol 107:271-277,
1981.
10. Welling DB, Nagaraja HN: Endolymphatic mastoid shunt: A
reevaluation of effi cacy. Otolaryngol Head Neck Surg 122:340-
345, 2000.
11. Thomsen J, Bonding P, Becker B, et al: The non-specifi c effect
of endolymphatic sac surgery in treatment of Ménière’s disease:
A prospective, randomized controlled study comparing “classic”
endolymphatic sac surgery with the insertion of a ventilating tube
in the tympanic membrane. Acta Otolaryngol 118:769-773,
1998.
12. Stockwell CM, Graham MD: Vestibular compensation following
labyrinthectomy and vestibular neurectomy. Second Interna-
tional Symposium on Ménière’s Disease. Kugler & Ghedini
Publications, 1989.
13. Goebel JA, Gianoli G: Vestibular neuritis. In Jackler RK, Brack-
man DE (eds): Neurotology, 2nd ed. Philadelphia, Mosby, 2005,
pp 484-488.
14. Minor LB, Solomon D, Zinreich JS, et al: Sound- and/or
pressure-induced vertigo due to bone dehiscence of the superior
semicircular canal. Arch Otolaryngol Head Neck Surg 124:249-
258, 1998.
15. Branstetter BF 4th, Harrigal C, Escott EJ, et al: Superior semicir-
cular canal dehiscence: Oblique reformatted CT images for diag-
nosis. Radiology 238:938-942, 2006.
16. Williamson RA, Vrabec JT, Coker NJ, et al: Coronal computed
tomography prevalence of superior semicircular canal dehis-
cence. Otolaryngol Head Neck Surg 129:481-489, 2003.
17. Minor LB: Clinical manifestations of superior semicircular canal
dehiscence. Laryngoscope 115:1717-1727, 2005.
18. Hirsch BE: Surgical treatment of vestibular disorders. Neurol Clin
23:875-891, viii, 2005.
19. Parnes LS: Posterior semicircular canal occlusion for benign par-
oxysmal positional vertigo. In Brackmann D, Shelton C, Arriaga
M (eds): Otologic Surgery. Philadelphia: WB Saunders, 2001,
pp 448-454.
20. Kartush JM, Sargent EW: Posterior semicircular canal occlusion
for benign paroxysmal positional vertigo—CO2 laser-assisted
technique: Preliminary results. Laryngoscope 105(3 Pt 1):268-
274, 1995.
21. Megerian CA, Hanekamp JS, Cosenza MJ, et al: Selective retrosig-
moid vestibular neurectomy without internal auditory canal drill-
out: an anatomic study. Otol Neurotol 23:218-223, 2002.
22. Ozdogmus O, Sezen O, Kubilay U, et al: Connections between
the facial, vestibular and cochlear nerve bundles within the inter-
nal auditory canal. J Anat 205:65-75, 2004.
23. Hillman TA, Kertesz TR, Hadley K, et al: Reversible peripheral
vestibulopathy: The treatment of superior canal dehiscence.
Otolaryngol Head Neck Surg 134:431-436, 2006.
PEARLS
• Surgery is indicated only for control of disabling
vestibular symptoms in patients with peripheral
vestibulopathy who have failed medical treatment
and vestibular rehabilitation.
• Vestibular ablation is contraindicated in those with
bilateral peripheral or central vestibulopathy.
• Chemical vestibular ablation using intratympanic
gentamicin has become the preferred primary
treatment modality for disabling unilateral
peripheral vestibulopathy because the risks of
treatment are signifi cantly lower than those incurred
with surgical ablation.
• The retrosigmoid and retromastoid approaches are
the preferred approaches for vestibular nerve section
in patients with aidable hearing in the affected ear.
• The posterior semicircular canal should be
fenestrated midway between its ampulla and the
common crus for PSCO to minimize the risk of
violating the vestibule and causing sensorineural
hearing loss.
PITFALLS
• Vestibular ablation in the presence of bilateral
peripheral vestibulopathy will result in disabling
oscillopsia.
• Suctioning in the vicinity of a fenestrated or
dehiscent semicircular canal may result in disruption
of the membranous labyrinth and postoperative
sensorineural hearing loss.
• Incomplete removal of the sensory neuroepithelium
within the posterior semicircular canal ampulla is
the most common cause of persistent vertigo
following a labyrinthectomy.
• The absence of consistent clear demarcation
between the cochlear and vestibular nerves in the
cerebellopontine cistern increases the risk of
inadvertent injury to the cochlear nerve in posterior
fossa approaches for vestibular nerve section.
• Middle fossa approaches necessitate temporal lobe
retraction for exposure of the middle fossa fl oor,
which is poorly tolerated in older individuals.
References
1. Welling DB, Parnes LS, O’Brien B, et al: Particulate matter in the
posterior semicircular canal. Laryngoscope 107:90-94, 1997.
2. Gacek RR: Pathology of benign paroxysmal positional vertigo
revisited. Ann Otol Rhinol Laryngol 112:574-582, 2003.
3. Schratzenstaller B, Wagner-Manslau C, Alexiou C, et al: High-
resolution three-dimensional magnetic resonance imaging of the

INDEX
Note: Page numbers followed by f or t indicate fi gures and tables, respectively.
A
Abbé fl ap, in large lip tumor excision, 188,
192f
Ablation
of frontal sinus, 118, 118f
radiofrequency, for tonsillectomy, 172
ABOX-CT (angiography–balloon occlusion–
xenon computed tomography), in
infratemporal fossa tumor, 999, 1000f,
1001t
Abrasion, facial, 872. See also Facial soft
tissue injuries.
Abscess
brain, in otitis media, 1235-1236, 1236f
ear, 1081-1082, 1082f
epidural, in otitis media, 1232-1233,
1233f
neck. See Neck abscess.
orbital, 140-141, 141f, 950, 950f
peritonsillar, 169, 672, 673f
tonsillectomy for, 177-178
postauricular, 1081, 1082, 1082f
retropharyngeal, third branchial cleft
remnant with, 653, 655f
subdural, in otitis media, 1234-1235
subperiosteal
of ear, 1082, 1082f
of forehead, 118, 118f
in third branchial arch cyst infection, 648
Acellular dermis graft, for endonasal skull
base reconstruction, 993, 993f
Achalasia, cricopharyngeal, 461, 461f
Acoustic neuroma, 1295-1317
bilateral, 1298
clinical presentation in, 1296
hearing loss evaluation in, 1299, 1299f
historical background on, 1295-1296
lateral, 1297, 1297f
observation option for, 1296
pathology of, 1313, 1314f
radiation therapy for, 1296
radiologic imaging of, 1299-1300,
1299f-1301f
stereotactic radiosurgery for, 1297
surgical management of
anesthesia for, 1301
complications of, 1314-1316
informed consent for, 1301
middle fossa approach in, 1298,
1306-1309, 1307f-1309f
patient selection and counseling in,
1296-1298, 1297f
pearls and pitfalls in, 1317
postoperative management in, 1314,
1315t
preoperative planning for, 1298-1301,
1299f-1301f
Acoustic neuroma (Continued)
retrosigmoid approach in, 1298,
1309-1313, 1310f-1313f
techniques in, 1301-1313
translabyrinthine approach in, 1298,
1301-1306, 1312f-1315f
vestibular tests in, 1299
Acoustic rhinometry, in choanal atresia, 27
Acrylic splint
after juvenile angiofi broma surgery, 45,
46f
after reconstruction at cleft site, 788
after total maxillectomy, 81, 84f
Acyclovir, for Bell’s palsy, 1259
Adenocarcinoma
of cervical esophagus, 474
polymorphous
of hard palate, 205, 206f
of soft palate, 199, 200f
of thyroid gland, 542, 543f
Adenoid(s)
anatomy of, 33
hypertrophy of, 33, 34, 34f
Adenoid cystic carcinoma, of soft palate,
199
Adenoid facies, 33
Adenoidectomy, 33-37
complications of, 37
patient selection for, 33-34
in patients with cleft palate, 782-783
pearls and pitfalls in, 37
postoperative management of, 36
preoperative evaluation in, 34-35, 35f
technique of, 35-36, 35f, 36f
with tonsillectomy, 33-34, 35, 170, 174.
See also Tonsillectomy.
Adenoma
parathyroid, 561-562
pleomorphic
of hard palate, 205
of parotid gland, 511, 516, 517
in prestyloid parapharyngeal space, 525,
527f, 529
of soft palate, 199
Adenotome, for adenoidectomy, 36
Adhesions, lip, for facial cleft repair, 769,
770f
Adipose tissue obliteration. See Fat
obliteration.
Adnexal neoplasm, 725
Advancement fl ap
helical rim, for ear reconstruction, 729,
730f
wedge/block excision with, for large lip
tumor, 186-187, 189f, 190f
Aerodigestive tract, upper, recurrent
respiratory papillomatosis of, 323-327
Afrin test, in obstructive sleep apnea, 153,
153f
Agger nasi cells, 92
Air, intrathecal injection of, in cerebrospinal
fl uid rhinorrhea, 1054
Air embolism
during acoustic neuroma surgery, 1315
during anterior cranial base surgery, 985
Airway
in choanal atresia, 27
management of
in glottic enlargement surgery, 312
in laryngeal trauma, 350-351, 353
in midfacial and upper facial fracture,
912
obstruction of
in facial clefts, 768
after laryngeal carcinoma endoscopic
surgery, 390
after laryngeal surgery, 376
after total glossectomy, 227
after vocal fold augmentation/injection,
321
reconstruction of, for obstructive sleep
apnea, 156-158, 156f-158f
thyroid cancer metastasis to, 551
Airway fi re, 385, 584
Alar retraction/collapse, after rhinoplasty,
818
Allergic rhinitis, diagnostic endoscopy in, 1
Alligator forceps removal of nasal polyps, 4
Alloplastic material, for orbital
reconstruction, 943
Alveolar cleft bone grafting, 787-788, 787f
Aminoglycoside, intratympanic, 1084-1087,
1086f
Amyloid polyneuropathy, lip biopsy in, 491
Amyloidosis, macroglossia in, 161, 162f
Anacusis, after temporal bone fracture,
1373-1374
Analgesics, after tonsillectomy, 178
Anaplastic cancer, of thyroid gland, 542
Anesthesia
for acoustic neuroma surgery, 1301
for blepharoplasty, 858
for dacryocystorhinostomy, 969
of ear
regional, 1077-1078, 1077f-1078f
topical, 1075-1077, 1076f
for endoscopic maxillary sinus surgery, 53,
53f
for esophagoscopy, 446
for ethmoid sinus endoscopic surgery, 93
for facial repair and reconstruction,
875-876
for fl exible bronchoscopy, 569
for intranasal ethmoidectomy, 101
I-1

I-2
Index
Volume 1: pages 1-718
Volume 2: pages 719-1410
Anesthesia (Continued)
of larynx, 295-296, 296f
for mastoidectomy, 1166
for middle ear reconstruction, 1180
for myringoplasty, 1135, 1136f
for nasal fracture reduction, 920
for nasal polypectomy, 100
of nasopharynx, 295
for otosclerosis surgery, 1192, 1193-1194
for percutaneous dilatational
tracheostomy, 587
for phonomicrosurgery, 305
for postoperative tonsillar bleeding, 179
for rhinoplasty, 808
for rhytidectomy, 846
for rigid bronchoscopy, 570
for salivary duct calculi removal, 487
standard monitoring during, 1001t
for stapedectomy, 1192, 1193-1194
for temporal bone resection, 1279
for thyroid surgery, 546
for transoral vocal fold augmentation,
295-296, 296f
for tympanoplasty, 1135, 1137-1138, 1138f
Angina, Ludwig’s, 671
Angiofi broma, nasopharyngeal, juvenile.
See Juvenile angiofi broma.
Angiography
in anterior cranial base tumor, 982
in carotid body tumor, 664, 665f
computed tomography
in internal carotid artery
pseudoaneurysm, 145, 145f
in lip cancer, 185
with embolization
for epistaxis, 9-10
for juvenile angiofi broma, 41, 41f, 42
in glomus tumor, 1323, 1323f, 1324, 1324f
in infratemporal fossa tumor, 999, 1000f
in juvenile angiofi broma, 39, 41, 41f
magnetic resonance
in glomus tumor, 1322-1323, 1323f
in infratemporal fossa tumor, 999
in temporal bone cholesterol
granuloma and epidermoid tumor,
1343
in parapharyngeal space tumor, 661t
in temporal bone carcinoma, 1278
Angiography–balloon occlusion–xenon
computed tomography (ABOX-CT), in
infratemporal fossa tumor, 999, 1000f,
1001t
Angiosarcoma, of head and neck, 726
Animal bite wounds, facial, 874, 875f, 876t,
882f
Ansa hypoglossi, in radical neck dissection,
696, 696f
Anterior commissure
recurrent respiratory papillomatosis
removal from, 325, 325f
webbing of, laryngofi ssure and, 335, 338
Antibiotics
after adenoidectomy and tonsillectomy,
35, 178
in anterior cranial base surgery, 984-985
for bite wounds, 874
in cerebrospinal fl uid leak, 135, 1057
for deep neck abscess, 675
after ethmoid sinus endoscopic surgery,
97
Antibiotics (Continued)
in facial fracture repair, 931-932
in frontal sinus fracture, 911
in laryngeal stenosis, 362
in laryngofi ssure, 336
in neck dissection, 690
for orbital abscess, 141
for otitis media in children, 1124-1125
in segmental mandibulectomy, 267
in temporal bone resection, 1279
in total laryngectomy, 423
in tracheal stenosis surgery, 606
for tympanostomy tube otorrhea,
1129-1130
after tympanostomy tube placement, 1129
Anticholinergics, for Frey’s syndrome, 495
Antiviral agents, for Bell’s palsy, 1259
Antoni A and B histologic patterns, 1313,
1314f
Antrochoanal polyp
computed tomography of, 59, 59f
removal of, 61
surgical management of, 127-129
complications of, 129
endoscopic, 128
external approach to, 127, 128, 129f
patient selection for, 127, 128f
pearls and pitfalls in, 129
postoperative care in, 128-129
preoperative planning for, 127-128,
128f
Antrostomy
anterior (Caldwell-Luc procedure), 57-62
anatomy in, 57-58, 58f, 59f
for antrochoanal polyp, 127, 128, 129f
complications of, 55, 55f
oral-antral fi stula after, 63
patient selection for, 58-60, 59f, 59t
pearls and pitfalls in, 62
postoperative care in, 62
preoperative planning for, 60
technique of, 60-62, 60f-62f
inferior meatal, 51
middle meatal
in endonasal approach to sella/
parasellar areas, 1049, 1049f
in postoperative bleeding, 146
Apnea, sleep. See Sleep apnea, obstructive.
Apneic index, 151
Applebaum hydroxyapatite prosthesis, 1155,
1156f
Apron fl ap
in laryngeal trauma surgery, 353
in supraglottic laryngectomy, 398, 399f
Apron incision, for total laryngectomy, 423,
424f
Arachnoid granulations, cerebrospinal fl uid
leak in, 1359
Arachnoidal dissection, in facial nerve
decompression surgery, 1389, 1389f
Arch bar, maxillomandibular fi xation with
for mandibular fracture, 888-889,
889f-891f
for midfacial and upper facial fracture,
912
Arcuate eminence, 1308, 1308f
Areolar graft, in tympanoplasty, 1139, 1140f,
1142, 1142f, 1143f
Arm fl ap, lateral, 741-742, 742f
Arrhythmias, during esophagoscopy, 448-449
Arterial anastomosis, for reconstruction of
extended maxillectomy with orbital
exenteration, 88
Aryepiglottic fold tumor, partial
laryngopharyngectomy for, 408-409,
409f
Arytenoid adduction
complications of, 333
medialization laryngoplasty with, 331-332,
332f
preoperative planning for, 330
Arytenoid suturing, after supracricoid partial
laryngectomy with
cricohyoidoepiglottopexy, 405, 406f
Arytenoidectomy
medial
laser, 313, 313f
for posterior glottic stenosis, 367
open, 314
total, 313, 313f
Aspiration
algorithm for evaluation and management
of, 597f
chronic
nonsurgical treatment of, 597t
pathologic states associated with, 595,
597t
surgical treatment of, 595-596, 597t
during esophagoscopy, 448
laryngotracheal separation for, 595-601.
See also Laryngotracheal separation.
Lindeman’s procedure for, 595, 596
Aspiration biopsy, fi ne-needle. See Fine-
needle aspiration biopsy (FNAB).
Aspiration pneumonia, after temporal bone
resection, 1291
Asymmetries, after blepharoplasty, 868
Audiologic testing
in aural atresia, 1115
in cochlear implant candidate, 1378
in middle ear malformations, 1179
in otosclerosis, 1189-1190, 1190f
Audiometry
in acoustic neuroma, 1299, 1299f
improvements in, 1295-1296
pure-tone, 1148, 1149f
in temporal bone fracture, 1369
in vertigo, 1395-1396
Auditory brainstem evoked responses
in acoustic neuroma, 1299, 1299f
monitoring of, during facial nerve
decompression, 1388, 1390
Auditory canal. See External auditory canal;
Internal auditory canal.
Aural speculum, for cerumen disimpaction,
1079
Auricular abscess, 1082
Auricular anatomy, 792f, 1077, 1077f
Auricular hematoma, 1079-1081
incision and drainage of, 1079-1080,
1080f
needle aspiration of, 1080-1081
Auricular nerve, greater, anatomy of, 681f,
682
Auricular nerve graft, greater, for facial
nerve repair, 521, 1248-1249, 1248f,
1268, 1371, 1372f
Auricular reconstruction
for microtia, 797-805, 798f-804f. See also
Microtia.

Index
I-3
Volume 1: pages 1-718
Volume 2: pages 719-1410
Auricular reconstruction (Continued)
for protuberant ear, 791-797, 792f-795f.
See also Otoplasty.
for skin cancer, 729, 730f
Auriculotemporal syndrome. See Frey’s
syndrome.
Autoimmune disease
laryngeal stenosis in, 359, 360f
tracheal stenosis in, 604
Autologous material, for vocal fold
augmentation/injection, 319, 319t
Avulsion, in facial soft tissue injuries, 874,
876f
B
Baha system, 1209-1217, 1210f. See also
Hearing aid, bone-anchored.
Baillarger’s syndrome. See Frey’s syndrome.
Ballenger swivel knife, in septoplasty, 21, 22f
Balloon catheter, in endonasal skull base
reconstruction, 994
Balloon occlusion test, of internal carotid
artery, 1324
Barium esophagography
in cervical esophageal cancer, 475-476,
476f
in Zenker’s diverticulum, 461, 461f
Barotrauma, tympanostomy tube placement
after, 1126
Basal cell carcinoma
of head and neck, 724, 724f
of lip, 185
Basal cell nevus syndrome, skin cancer in,
721
“Bath plug” graft, for skull defect repair,
134, 134f
Beckwith-Wiedemann syndrome,
macroglossia in, 161-162
Belenky-Medina classifi cation of fi rst
branchial cleft remnants, 646
Bell’s palsy
in facial nerve tumor, 1245
facial paralysis in, 1259
Belmont-Grundfast model of fi rst branchial
cleft remnants, 646-647
Benign paroxysmal positional vertigo
(BPPV), 1393-1394
Berry’s suspensory ligament, transection of,
in thyroid lobectomy, 548f, 550
Beta-trace protein (beta2 transferrin)
in cerebrospinal fl uid otorrhea, 1361
in cerebrospinal fl uid rhinorrhea, 131,
132, 1054
in perilymphatic fi stula, 1221, 1224
Bick procedures, in eye reanimation,
975-976, 976f-977f
Biliary cirrhosis, primary, 491-492
Bill’s bar, in acoustic neuroma surgery,
1303, 1303f
Bilobed fl ap
for nasal reconstruction, 731, 732f
Zitelli’s, for nasal skin coverage, 832, 834,
835f
Biofi lm
chronic bacterial sinusitis with, 4-5
in otitis media with effusion, 1124
Bioform injection needle, 296
Bioimplantable material, for vocal fold
augmentation/injection, 319, 319t
Biopsy
of external auditory canal mass,
1082-1084, 1083f, 1083t
fi ne-needle. See Fine-needle aspiration
biopsy (FNAB).
of fl oor of mouth cancer, 244
of hard palate cancer, 207-208
of infratemporal fossa tumor, 999-1001
of juvenile angiofi broma, 41, 42f
laryngeal, offi ce-based, 300, 300f
of lip cancer, 184
of maxillary sinus tumor, 78
of minor salivary glands of lip, 491-493,
492f-493f
of parotid gland tumor, 513
of sentinel lymph node, 686-687
of skin cancer, 723
of tumor involving nasal cavity and
paranasal sinuses, 68
Bipedicled interposition fl ap, for nasal
lining, 826f, 827, 827f-828f
Bite wounds, facial, 874, 875f, 876t, 882f
Blair incision, for superfi cial lobe
parotidectomy, 513, 514f
Bleeding. See Hemorrhage.
Blepharoplasty, 857-870
anesthesia for, 858
complications of, 868-869
lower, 861-867
markings for, 864, 864f
pearls and pitfalls in, 869-870
postoperative management of, 867
transconjunctival approach to, 861-864,
862f-864f
transcutaneous approach to, 864-867,
864f-868f
patient selection for, 857
preoperative planning for, 857-858
upper, 858-861
markings for, 858-859, 859f
postoperative management of, 861
surgical technique for, 859-861,
859f-860f
Blepharospasm, 1386, 1386t
Blindness
after blepharoplasty, 869
from orbital emphysema, 141, 142f
Bondy-modifi ed radical mastoidectomy,
1163, 1173, 1173f
Bone graft
for craniofacial skeleton reconstruction,
1064, 1065f
maxillary and alveolar cleft, 787-788, 787f
for middle fossa defect repair, 1373,
1373f
for midline nasal support, 829, 832f
for tegmen defect, 1363, 1363f
Bone invasion, survival and, 256, 258f
Bone-anchored hearing aid. See Hearing aid,
bone-anchored.
Botulinum toxin injection, 292-295
approaches to, 292-293, 292f
with electromyographic guidance, 294,
295f
for essential voice tremor, 293
for Frey’s syndrome, 495, 497-498, 497f
indications for, 291
with laryngoscopic guidance (two-person),
295
pearls and pitfalls in, 300-301
Botulinum toxin injection (Continued)
of posterior cricoarytenoid muscle, 294,
295f
postprocedure care/complications of, 299
preoperative planning for, 292, 292f
reconstitution and dilution procedure in,
292
serotypes for, 292
for spasmodic dysphonia, 293
of thyroarytenoid-lateral cricoarytenoid
muscle complex, 294, 295f
for upper esophageal sphincter
dysfunction, 460
for vocal fold granuloma, 293-294, 294f
Brachial plexus
anatomy of, 683f, 684-685
in radical neck dissection, 694, 694f
Brain abscess, in otitis media, 1235-1236,
1236f
Brainstem auditory evoked responses
in acoustic neuroma, 1299, 1299f
monitoring of, during facial nerve
decompression, 1388, 1390
Branchial arch cyst infection, third, 648
Branchial cleft carcinoma, 648-649
Branchial cleft remnants, 645-656
developmental anatomy of, 645
differential diagnosis of, 645
fi rst
description of, 645-647, 647f
excision of, 650-652, 650f, 651f
preauricular
description of, 646, 646f
excision of, 650, 651f
second and third
description of, 647-648, 647f-648f
excision of, 652-653, 652f-655f
surgical excision of
complications of, 653, 655
patient selection for, 648-649, 648f, 649f
pearls and pitfalls in, 655-656
postoperative management after, 653
preoperative planning for, 649-650, 649f
techniques for, 650-653
Bronchoscope(s)
fl exible fi beroptic and “chip-tip,” 566-567,
568f
rigid, 567-568, 568f
Bronchoscopy, 565-575
anatomic considerations in, 565, 566f
development of, 565-566
equipment for, 566-568, 567f-568f
fl exible
equipment for, 566-567, 568f
technique for, 569-570
for foreign body removal, 573-574, 573f,
573t, 574f
in laryngeal carcinoma, 422
patient selection for, 568-569, 569t
rigid
equipment for, 567-568, 568f
technique for, 570-573, 570f-573f
techniques for, 569-574
Brow defect repair, 729
Brow incision, for superior orbital rim
fracture repair, 918
Brow ptosis, blepharoplasty and, 857
Brow-lift, in eye reanimation, 974
Bubbles, on computed tomography of
maxillary sinus accessory ostia, 52, 52f

I-4
Index
Volume 1: pages 1-718
Volume 2: pages 719-1410
Buccal space tumor, 533-538
anatomic considerations in, 533, 534f
differential diagnosis of, 534, 534t
excision of
complications of, 538
pearls and pitfalls in, 538
postoperative management after, 538
preoperative planning for, 536
techniques for, 536-538, 537f-538f
preoperative evaluation of, 533-536,
535f-536f
Buccogingival incision, 269, 270f. See also
Gingivobuccal sulcus incision.
Burns
caustic, laryngeal stenosis after, 358
facial, 873
C
Cable graft, for facial nerve repair, 521, 521f
Calcifi cation
of cervical spine, 710, 712f
in thyroglossal duct cyst, 636, 636f
Calcitonin, in medullary carcinoma, 542
Calcitriol, for hypoparathyroidism, 555
Calcium, administration of, for
hypocalcemia, 555
Caldwell-Luc procedure. See Antrostomy,
anterior (Caldwell-Luc procedure).
Canal cholesteatoma. See Cholesteatoma,
canal.
Canal wall down mastoidectomy, 1163,
1171-1173, 1172f-1173f
Canal wall up mastoidectomy, 1163,
1167-1170, 1168f-1170f, 1175-1176
Cancer. See also specifi c anatomic site and
neoplasm.
of cervical esophagus, 473-483
extracapsular spread of, 679, 680f
of fl oor of mouth, 241-252
of hard palate, 205-215
of larynx, 379-391
of lip, 183-193
of nose, 728
of oropharynx, 283-289
periorbital, 727-728
of skin, 719-736
of soft palate, 199-202, 200f-202f
staging of. See Staging.
of supraglottic larynx, 393-409
of temporal bone, 1271-1292
of thyroid gland. See Thyroid cancer.
of tongue, 217-227
Canine fossa
anatomy of, 58, 59f
exposure of, in anterior antrostomy,
60-61, 61f
Canthal ligament, medial, repositioning of,
in medial maxillectomy and lateral
rhinotomy, 71
Canthopexy, lateral transorbital, in eye
reanimation, 976
Canthotomy, lateral, with inferior
cantholysis
for orbital abscess, 140-141, 141f
in orbital fl oor fracture repair, 918,
919f-920f
for retrobulbar hemorrhage, 139-140, 140f
Carbon dioxide laser, 383. See also Laser
surgery.
Carcinoma. See also Adenocarcinoma;
Cancer.
adenoid cystic, of soft palate, 199
basal cell
of head and neck, 724, 724f
of lip, 185
branchial cleft, 648-649
medullary, of thyroid gland, 542
Merkel cell, of head and neck, 725-726
papillary, arising in thyroglossal duct cyst,
636-637, 636f
sebaceous, of head and neck, 725
squamous cell. See Squamous cell
carcinoma.
verrucous
of cervical esophagus, 474
of larynx, 381-382
Cardiopulmonary reserve, supraglottic
laryngectomy and, 397-398
Carhart’s notch, 1190, 1190f
Carotid artery
aberrant, 1185-1186, 1186f
anatomy of, 685
identifi cation of, in thyroid lobectomy,
548f, 549
infection of, 677
internal
ABOX-CT of, 999, 1000f, 1001t
anatomy of, 144, 144f, 145f
balloon occlusion test of, 1324
encasement of, as contraindication to
neck dissection, 688-689, 690f
injury to
during endonasal surgery, 1051
during glomus tumor surgery, 1335
during infratemporal fossa surgery,
1019-1020
during neck dissection, 704
during temporal bone resection,
1289-1290
pseudoaneurysm of
computed tomography angiography
in, 145, 145f
post-traumatic, 1374, 1374f
segments of, 1046, 1046f
surgical repair of
postoperative management of, 149,
149f
preoperative planning for, 145-146,
145f
petrous
exposure of, 148, 148f
localization of, 1050, 1050f
middle fossa approach to, 1024-1025,
1027-1032, 1027f-1031f
Carotid body tumor
diagnosis of, 664, 665f
excision of, 667-668, 667f, 668f
Shamblin classifi cation of, 664, 666,
666f
Carotid canal, 1046, 1047f
Carotid sheath
in cervical spine surgery, 709, 710f
in radical neck dissection, 695, 695f
Carotid-vertebral space, 710, 711f
Cartilage graft
for microtia reconstruction, 798-799,
798f-800f
for nasal alar reconstruction, 829-830,
833f
Cartilage graft (Continued)
for nasal reconstruction, 830
for posterior cricoid area, 370, 372f
Cartilage repair, in laryngeal trauma, 354,
354f, 355f
Cartilage-contouring horizontal sutures, for
otoplasty, 793-794, 794f
Caulifl ower ear, 1079
Caustic burns, laryngeal stenosis after, 358
Cautery
for anterior epistaxis, 3
suction, for adenoidectomy, 36, 36f
for tonsillectomy, 173, 176
Cellulitis, after foreign body removal from
ear, 1097
Cephalic trim, in nasal tip surgery, 813, 813f
Cerebellar artery
anterior inferior, injury to, during
vestibular nerve section, 1409
posterior inferior, decompression of, in
hemifacial spasm, 1390
Cerebellopontine angle, congenital
epidermoid tumor of, 1341
Cerebral blood fl ow, ABOX-CT of, 999,
1000f, 1001t
Cerebral edema, after petrosal approach to
cranial base tumor, 1042
Cerebral ischemia, after infratemporal fossa
surgery, 1020
Cerebrospinal fl uid analysis, in anterior
cranial base tumor, 982
Cerebrospinal fl uid leak
after acoustic neuroma surgery,
1315-1316
after anterior cranial base surgery, 995
classifi cation of, 1053
after cochlear implant surgery, 1383
after endonasal surgery, 1051
after facial nerve decompression, 1391
after facial nerve tumor surgery, 1255
after glomus tumor surgery, 1334
after infratemporal fossa surgery,
1020-1021
after labyrinthectomy, 1408-1409
after petrosal approach to cranial base
tumor, 1041
signs and symptoms of, 1360
after temporal bone fracture, 1368,
1373-1374, 1373f
after temporal bone resection, 1290
through ear. See Cerebrospinal fl uid
otorrhea.
through nose. See Cerebrospinal fl uid
rhinorrhea.
Cerebrospinal fl uid otorrhea, 1359-1366
causes of, 1359-1360, 1360f, 1360t
persistent, 1365-1366
surgery for
defect repair methods in, 1362-1364,
1362f-1365f
middle fossa approach in, 1361-1362,
1364, 1364f
patient selection in, 1360
pearls and pitfalls in, 1366
postoperative care in, 1365-1366
preoperative planning of, 1361, 1361f,
1362f
techniques in, 1361-1365, 1362f-1365f
transmastoid approach in, 1361, 1362,
1362f, 1363, 1363f

Index
I-5
Volume 1: pages 1-718
Volume 2: pages 719-1410
Cerebrospinal fl uid rhinorrhea, 131-136
arising from ethmoid sinus roof and
cribriform plate, 133-134, 133f-135f,
1056
arising from frontal sinus, 135, 1057
arising from sella, 135
arising from sphenoid sinus, 134-135,
135f, 1056-1057, 1057f
after cranial base reconstruction, 1066
endoscopic management of, 1053-1059,
1057f, 1058f
patient selection for, 132, 1054
pearls and pitfalls in, 136
postoperative management of, 135-136,
1057-1058, 1058f
preoperative planning for, 132-133,
1054-1056, 1055f
techniques for, 133-135, 133f-135f,
1056-1057, 1057f
after facial fracture, 931
with high-pressure hydrocephalus risk,
1057-1058, 1058f
after medial maxillectomy, 72
after optic nerve decompression, 959
after septoplasty, 24
Cerumen, disimpaction of, 1078-1079
Cervical. See also Neck entries.
Cervical esophageal cancer, 473-483
anatomic considerations in, 474
chemoradiotherapy for, 473-474, 478
epidemiology of, 474
pathophysiology of, 474
pearls and pitfalls in, 482-483
postoperative management and
complications of, 482
staging of, 477, 477t
surgical management of
patient selection for, 474-475
preoperative planning for, 475-478,
476f
techniques for, 478-481, 479f-480f
symptoms of, 473
Cervical esophagoscope, in
tracheoesophageal puncture, 434, 435,
435f-436f
Cervical esophagus
benign tumor of, 474
cancer of. See Cervical esophageal cancer.
penetrating trauma to, 451-456
complications of, 456
evaluation and diagnosis of, 451-452,
452f
iatrogenic, 451-452
medical treatment of, 453
pearls and pitfalls in, 456
postoperative management of, 455-456
surgical treatment of, 453-455, 453f-455f
Cervical fasciitis, necrotizing, 676
Cervical ganglion, superior, schwannoma of,
668
Cervical incision, for thyroid surgery,
546-547, 547f
Cervical lymph nodes
drainage by, predictability of, 686
levels of, 681, 681f, 686
metastasis to, 208, 211
of fl oor of mouth cancer, 241, 243, 244f
occult, 679-680
in neck cancer staging, 679, 680f
sentinel, biopsy of, 686-687
Cervical nerves
in radical neck dissection, 695, 695f
in selective neck dissection, 701, 702f
Cervical plexus, anatomy of, 685
Cervical spine
chordoma of, 712, 712f
magnetic resonance imaging of, 710f, 712
neurophysiologic monitoring of, 712
osteophytes of, 710, 711f
Cervical spine surgery, 709-717
anatomy in, 709-710, 710f-711f
anterior
patient selection for, 710-711, 710f-712f
technique of, 713-715, 713f-715f
billing codes for, 717
complications of, 717
endoscopic, 1069-1073
anatomy for, 1069
comparison between, 1070-1071
complications of, 1072-1073
patient selection for, 1069-1070, 1070f
pearls and pitfalls in, 1073
postoperative management of, 1072
preoperative evaluation and planning
for, 1070
transnasal, 1071-1072, 1072f, 1073
transoral/transpalatal, 1071, 1071f,
1072-1073
lateral
patient selection for, 711-712, 712f
technique of, 715-716, 716f
patient selection for, 710-712, 710f-712f
pearls and pitfalls in, 717
postoperative care in, 716-717
preoperative evaluation in, 710f, 712
preoperative planning for, 712-713
Cervical spondylosis, 710, 710f
Cervicofacial fl ap, in postauricular
(transtemporal) infratemporal fossa
surgery, 1009, 1013f
Cervicopectoral skin fl ap, 762, 762f
Cheek, cancer on, 728, 733, 735f
Cheek defects, free fl ap for, 821-822,
823f-825f
Chemoradiotherapy
for cervical esophageal cancer, 473-474,
478
for laryngeal carcinoma, 421-422
Chemotherapy
for juvenile angiofi broma, 43
for temporal bone carcinoma, 1276
topical, for skin cancer, 721
Children
bone-anchored hearing aid in, 1215-1216
cochlear implant in, 1378, 1378t
fi ne-needle aspiration biopsy in, 630
hearing loss in, progressive versus stable,
1179
laryngeal trauma in, 349
mandibular fracture in, 898, 899f
otitis media in, 1124-1125
otosclerosis in, 1191-1192
subglottic stenosis in, 371, 375, 375f
thyroid cancer in, 542
tracheocutaneous fi stula and depressed
scar in, 619-620, 621
tympanocentesis in, 1127-1128, 1128f
Choanal atresia, 27-32
bilateral, 27
congenital anomalies associated with, 27
Choanal atresia (Continued)
embryology of, 27
repair of
patient selection for, 28-29
pearls and pitfalls in, 31-32
postoperative care in, 31
powered instrumentation for, 28-29
preoperative planning for, 29, 29f
sublabial transseptal, 31
transnasal endoscopic technique for,
28, 28f, 30
transnasal puncture technique for, 30,
31f
transpalatal technique for, 28, 28f, 30,
31f
unilateral, 27-28
Cholesteatoma
canal, 1083, 1107-1111, 1108f-1109f
complications of, 1110
pearls and pitfalls in, 1110-1111
postoperative management of, 1110
preoperative evaluation of, 1109
surgical management of
patient selection for, 1109
techniques for, 1109-1110,
1109f-1110f
congenital, 1186, 1340, 1340f
mastoidectomy for, 1164, 1164f, 1165f
removal of, 1141
Cholesterol granuloma of temporal bone
overview of, 1339, 1340f
preoperative evaluation of, 1343-1344
radiologic imaging of, 1341, 1341f,
1342-1343, 1342t, 1343f
surgical management of
complications of, 1354-1355
decision-making for, 1344-1345, 1344t
pearls and pitfalls in, 1356
postoperative care after, 1353-1354,
1354f
preauricular subtemporal infratemporal
approach in, 1351-1353,
1352f-1353f
retrofacial infralabyrinthine approach
in, 1348-1349, 1349f
transcanal infracochlear approach in,
1347-1348, 1347f-1348f
transcochlear approach in, 1350
translabyrinthine approach in,
1349-1350, 1349f
transnasal approach in, 1353
tympanomastoid exteriorization in,
1350-1351, 1350f-1351f
tympanomeatal approach in, 1346-1347,
1346f
Chondrocutaneous graft
composite, for nasal skin coverage, 832,
833f, 834f
in microtia reconstruction, 802, 803f,
804f
Chorda tympani nerve
aberrant anatomy of, 1181
injury to, during stapes surgery, 1203-1204
Chordoma, of cervical spine, 712, 712f
Choristoma, 1186
Chyle fi stula, after neck dissection, 704, 705
Cicatricial pemphigoid, diagnostic
endoscopy in, 2
Cidofovir, for recurrent respiratory
papillomatosis, 327

I-6
Index
Volume 1: pages 1-718
Volume 2: pages 719-1410
Circumzygomatic wires, in maxillary arch
bar, 889, 891f
Cirrhosis, biliary, primary, 491-492
Cisternography, computed tomography, in
cerebrospinal fl uid rhinorrhea, 131-132,
133, 1054, 1055f, 1056
Cleft(s), facial
airway obstruction in patients with, 768
classifi cation of, 765-766, 766t
interdisciplinary care for, 766-767
lip adhesion technique for, 769, 770f
pearls and pitfalls in, 789
prenatal diagnosis of, 767-768
presurgical orthopedic devices for,
768-769, 769f
sequencing of procedures for, 768, 768t
spectrum of, 765, 766f
Cleft bone grafting, maxillary and alveolar,
787-788, 787f
Cleft lip repair
bilateral, 773-776, 774f-775f
unilateral, 770-773, 771f-773f
Cleft lip revision, 776
Cleft orthognathic surgery, 788-789, 789f
Cleft palate
adenoidectomy and tonsillectomy in
patients with, 782-783
otitis media with effusion in patients with,
780-781
speech abnormalities associated with, 780,
780t
submucous, 781
palpation of, 35, 35f
unilateral, anatomy of, 781f
Cleft palate repair, 776-780
Furlow palatoplasty in, 778-780, 779f
goals of, 776-778, 777f
palatal fi stula after, repair of, 785-787
two-fl ap palatoplasty with intravelar
veloplasty in, 776-778, 777f
velopharyngeal incompetence after,
781-782, 781f
adenotonsillar hypertrophy and, 783
surgery for, 783-785, 784f-786f
V-Y pushback with intravelar veloplasty in,
778
Cleft rhinoplasty, 788
Clinoid, anterior, pneumatization of, in
optic nerve decompression, 957f, 958
Clivus. See also Petroclival tumor.
anatomy of, 1069
resection of, in transnasal procedures,
1071, 1072f
Coagulation disorders, after tonsillectomy,
178-179
Coblation tonsillectomy, 172
Coblator radiofrequency turbinate
reduction, 23-24
Cocaine, for anesthesia in nasal
polypectomy, 100
Cochlear implant, 1377-1383
complications of, 1382-1383, 1383f
extrusion of, prevention of, 1382,
1383f
FDA-approved, 1377
meningitis prophylaxis for, 1379, 1379t
patient selection for, 1377-1378, 1378t
pearls and pitfalls in, 1383
postoperative management of, 1382
preoperative evaluation for, 1378-1379
Cochlear implant (Continued)
surgical technique for, 1379-1382,
1380f-1382f
Cochlear nerve, injury to, during vestibular
nerve section, 1409
Cochleostomy, in cochlear implant surgery,
1381, 1381f, 1383
“Cold” or sharp dissection, for tonsillectomy,
173
Cold steel instrumentation
for anterior glottic stenosis, 365
for recurrent respiratory papillomatosis,
324, 325
Cold-water swimming, exostoses associated
with, 1099
Colonic interposition, esophageal
reconstruction with, 481
Commissure
anterior
recurrent respiratory papillomatosis
removal from, 325, 325f
webbing of, laryngofi ssure and, 335, 338
posterior
recurrent respiratory papillomatosis
removal from, 326, 326f
webbing of, laryngofi ssure for, 335-336
Common cold, diagnostic endoscopy in, 1
Composite chondrocutaneous graft, for
nasal skin coverage, 832, 833f, 834f
Composite resection, segmental
mandibulectomy in, 263
Computed tomography (CT)
in acoustic neuroma, 1300, 1301f
angiography–balloon occlusion–xenon
(ABOX-CT), in infratemporal fossa
tumor, 999, 1000f, 1001t
in anterior cranial base tumor, 981, 982f
in antrochoanal polyp, 128, 128f
in aural atresia, 1113, 1114f, 1114t, 1116
in branchial cleft remnants, 649, 649f
in buccal space tumor, 534
in cervical esophageal cancer, 476-477,
476f
in choanal atresia, 29, 29f
in cochlear implant candidate, 1379
in deep neck abscess, 675, 675f
in Eagle’s syndrome, 195, 196f
in endonasal approach to sella/parasellar
areas, 1048
of enlarged retropharyngeal lymph node,
285, 285f
of ethmoid sinus, 91, 92f, 93, 100
in external auditory canal exostoses and
osteomas, 1100-1101, 1101f
in facial nerve tumor, 1243, 1244f, 1246
fi ne-needle aspiration biopsy guided by,
633
in fl oor of mouth cancer, 243, 244f
in frontal sinusitis, 113, 115f
in glomus tumor, 1322, 1322f
in hard palate cancer, 206-207, 206f, 208,
208f
in hearing loss, 1148
high resolution
in cerebrospinal fl uid otorrhea, 1361,
1361f
in cerebrospinal fl uid rhinorrhea, 131,
133, 1054, 1055f, 1056
before mastoidectomy, 1165
in temporal bone fracture, 1369
Computed tomography (CT) (Continued)
in infratemporal fossa tumor, 999
in juvenile angiofi broma, 39, 40f
in laryngeal carcinoma, 422
in laryngeal stenosis, 360, 361f
in laryngeal trauma, 352, 352f
in laryngocele, 343, 343f
in laryngotracheal stenosis, 605, 605f
in mandibular fracture, 887-888
in maxillary fracture, 906
of maxillary sinus accessory ostia, 52, 52f
in maxillary sinus hypoplasia, 57, 58f
in maxillary sinus tumor, 78, 79f
in maxillary sinusitis, 59, 59f
in meningitis, 1232, 1232f
in middle ear malformations, 1178f,
1179
multiplanar re-formation, in oral cavity
cancer, 258
in nasal fracture, 909
in neck cancer staging, 688, 689f
in optic nerve decompression, 956f, 957
in orbital fracture, 908, 940
in parapharyngeal space tumor, 660,
661t
in parotid gland tumor, 512, 512f, 517,
518f
in penetrating neck trauma, 452, 452f
in prestyloid parapharyngeal space tumor,
525, 526f, 527f
in sphenoid sinus surgery, 108f, 109
in submandibular calculi, 506
in superior semicircular canal dehiscence
syndrome, 1394, 1395f
in supraglottic carcinoma, 396, 397f
in temporal bone carcinoma, 1277, 1277f
in temporal bone cholesterol granuloma
and epidermoid tumor, 1342-1343,
1342t, 1343f
with three-dimensional reconstruction, in
nasal-orbital-ethmoid (NOE) complex
fracture, 923, 926f
in thyroid cancer, 545, 545f
in tongue base and hypopharyngeal
tumor, 235
of tumor invasion into bone, 265, 265f
of tumor involving nasal cavity and
paranasal sinuses, 68, 68f, 69f
in zygomatic complex fracture, 907
Computed tomography angiography
in internal carotid artery pseudoaneurysm,
145, 145f
in lip cancer, 185
Computed tomography cisternography, in
cerebrospinal fl uid rhinorrhea, 131-132,
133, 1054, 1055f, 1056
Computer-assisted navigational technology,
in ethmoid sinus endoscopic surgery,
94
Concha bullosa, surgery of, 95, 95f
Conchal bowl, creation of, in microtia
reconstruction, 801-802, 802f-804f
Conchal cartilage, for nasal reconstruction,
830
Conchal fl ap
in exostoses surgery, 1102, 1103f
in tympanoplasty, 1138, 1139f
Conchal incision, for postauricular
(transtemporal) infratemporal fossa
surgery, 1009, 1012f

Index
I-7
Volume 1: pages 1-718
Volume 2: pages 719-1410
Condyle, mandibular
fracture involving, 897-898, 897f, 899f
osteotomy of, in preauricular
(subtemporal) infratemporal fossa
surgery, 1004, 1005f
Congenital anomalies
choanal atresia and, 27
of middle ear, 1177-1187
Conjunctival incision, for lower lid
blepharoplasty, 862
Continuous positive airway pressure, for
obstructive sleep apnea, 151, 152f
Contrast material, for esophagography, 445
Contusion, facial, 872
Cordotomy, transverse, in glottic
enlargement surgery, 312-313, 313f
Corneal injury, during lower lid
blepharoplasty, 868
Coronal incision
for Le Fort III fracture repair, 913-914,
913f, 914f
for orbital rim fracture repair, 914f, 918
Corticosteroids
for Bell’s palsy, 1259
after ethmoid sinus endoscopic surgery,
97
for facial fracture, 931
for facial paralysis, 1260, 1368
injection of
into frontal sinus, 4
into inferior turbinate, 4
intratympanic, 1084-1087, 1086f
for laryngeal stenosis, 362
for nasal polyps, 3-4
after tonsillectomy, 178
in tracheal stenosis surgery, 606
Cosmetic deformity, after infratemporal
fossa surgery, 1020f, 1021
Costal cartilage
for microtia reconstruction, 798-799,
798f-800f
for nasal reconstruction, 830
Cottle maneuver, 17, 20-21, 20f
Cranial base anatomy
infratemporal, 1005, 1007, 1007f
lateral, 1029f
Cranial base surgery
anterior, 979-996
complications of, 994-996
central nervous system/skull base,
995-996, 995f
metabolic, 994-995
vascular, 995
craniotomy in, 987, 988f
en bloc specimen removal in, 989, 990f
endoscopic techniques in, 991-994,
993f-994f
extracranial approaches in, 984, 984f
frontal lobe dura elevation in, 988-989,
988f
open, 985-991, 985f-991f
orbital wall resection in, 989, 989f
osteotomies in, 989, 989f, 993
patient selection for, 981-984, 981f-984f
pearls and pitfalls in, 996
postoperative management of, 994
preoperative planning for, 984-985
reconstruction after
endoscopic, 993-994, 993f-994f
open, 989-991, 990f-991f
Cranial base surgery (Continued)
scalp elevation in, 986-987, 986f, 987f
scalp incisions for, 985-986, 985f, 986f
endonasal, 1025, 1039-1040
evolution of, 1045
for infratemporal fossa tumor, 997-1021.
See also Infratemporal fossa surgery.
for middle and posterior fossae tumor,
1023-1043. See also Petrosal approach
to cranial base tumor.
reconstruction after, 1061-1068
complications of, 1065-1067
free fl ap in, 749, 749f
goals of, 1061, 1062t
materials for, 1062t
patient selection for, 1061
pearls and pitfalls in, 1068
postoperative care in, 1065
preoperative planning for, 1061
surgical techniques for, 1061-1065,
1062f-1067f
Cranial base tumor
anterior
choice of therapy for, 982, 982t
intracranial extension of, 979, 980f,
983-984, 983f, 984f
intranasal examination of, 981, 981f
preoperative evaluation of, 981-984,
981f-984f
signs and symptoms of, 979, 981f
types of, 979, 980t
lateral, zoning classifi cation for, 1024,
1024f
petrosal approach to, 1023-1043. See also
Petrosal approach to cranial base
tumor.
Cranial nerve injury
after acoustic neuroma surgery, 1316
after facial nerve decompression, 1391
after glomus tumor surgery, 1334
in laryngeal trauma, 351
after petrosal approach to cranial base
tumor, 1041-1042
Cranialization, of frontal sinus fracture,
929-930, 931f
Craniofacial abnormalities, tympanostomy
tube placement in patient with,
1125-1126
Craniofacial complete dysjunction (Le Fort
III fracture)
preoperative evaluation of, 906, 906f
treatment of, 913-914, 913f-915f
Craniofacial skeleton, reconstruction of,
1064, 1065f, 1066f
Cribriform plate, 100
cerebrospinal fl uid rhinorrhea arising
from, 133-134, 133f-135f, 1056
Cricoarytenoid joint, palpation of
in glottic enlargement surgery, 312
in posterior glottic stenosis, 314
Cricoarytenoid muscle, posterior
in arytenoid adduction, 331, 332f
localization and Botox injection of, 294,
295f
Cricohyoidoepiglottopexy, laryngectomy
with. See Laryngectomy, supracricoid
partial, with cricohyoidoepiglottopexy.
Cricoid cartilage
cancer involving, 411
trauma to, 352, 354
Cricoid split, anterior, for subglottic stenosis
in children, 371, 375, 375f
Cricopharyngeal achalasia, 461, 461f
Cricopharyngeal myotomy
indications for, 459
pearls and pitfalls in, 465
postoperative management of, 465
preoperative planning for, 462
after supraglottic laryngectomy, 400
technique of, 460, 462-463, 462f-463f
Cricopharyngeus muscle, dysfunction of,
459-465, 460f-464f. See also Zenker’s
diverticulum.
Cricothyroid joint, disarticulation of, 403,
404f
Cricothyroidotomy, laryngeal stenosis after,
358
Cricothyrotomy, in laryngeal trauma,
353
Cricotracheal resection, for tracheal stenosis,
613
Crista galli, removal of, in endoscopic
anterior cranial base surgery, 993
Cryosurgery, for skin cancer, 720
CT. See Computed tomography (CT).
Curettage with electrodesiccation, for skin
cancer, 720
Curette, for adenoidectomy, 35-36, 36f
Cutting and diamond burrs, in canal wall
reconstruction, 1109, 1110f
Cyanoacrylate tissue adhesives, for facial
repair and reconstruction, 877
CyberKnife system
for facial nerve tumor surgery, 1252-1253,
1253f
for glomus tumor surgery, 1324, 1325f
Cyst
branchial cleft. See Branchial cleft
remnants.
epidermal, of tongue, 163f
saccular, of larynx, 341-346. See also
Laryngocele.
thyroglossal duct. See Thyroglossal duct
cyst.
vocal fold, 303
Cystic neck mass, differential diagnosis of,
633
Cytometry, fl ow, 630
D
Dacryocystitis, 967
Dacryocystorhinostomy, 967-972
in medial maxillectomy, 70, 72f
patient selection for, 967-968
pearls and pitfalls in, 972
postoperative management of, 971-972,
972t
preoperative evaluation for, 969
surgical approaches for, 969-971,
969f-971f
in total maxillectomy, 80, 83f
Dacryoliths, 968
Dandy’s vein, 1311
Danger space, 709
Deafness. See Hearing loss.
Débridement. See also Microdébrider.
in facial soft tissue injuries, 872
Decannulation, in tracheostomy, 582-583
accidental, 592

I-8
Index
Volume 1: pages 1-718
Volume 2: pages 719-1410
Decompression
endolymphatic sac. See Endolymphatic sac
surgery.
facial nerve. See Facial nerve
decompression.
optic nerve. See Optic nerve
decompression.
orbital, 947-953. See also Orbital
decompression.
Deep vein thrombosis
after anterior cranial base surgery, 995
after petrosal approach to cranial base
tumor, 1042
prophylaxis against, in anterior cranial
base surgery, 984
Degloving procedure, midfacial
in anterior cranial base surgery, 984, 984f
medial maxillectomy and, 73, 74f
Deltopectoral muscle fl ap, 761, 761f
for esophageal reconstruction, 481
Dentition. See Tooth (teeth).
Dentoalveolar complex (Le Fort I) fracture
preoperative evaluation of, 906, 906f
treatment of, 912-913, 913f
Dentoalveolar fracture, 885, 889-890
Dermatochalasis, 857
Dermatofi brosarcoma protuberans, 726
Desaturation, after percutaneous dilatational
tracheostomy, 592
Dexamethasone
intratympanic, 1084-1087, 1086f
after orbital decompression, 952
Diabetes insipidus, after anterior cranial
base surgery, 994-995
Digastric muscle
anatomy of, 683-684, 684f
transposition of, for ramus mandibularis
defect, 841, 841f
Dilatation
for laryngeal stenosis, 361
for stomal stenosis, 624
for tracheal stenosis, 606
Dilatational tracheostomy, endoscopic
percutaneous, 585-593, 588f-591f
Dingman retractor, for transoral/
transpalatal surgery, 1071, 1071f
Diplopia
after cranial base reconstruction, 1067
in orbital blowout fracture, 938, 938f
Displacement, of frontal sinus fracture,
911-912, 927, 927f-930f, 929
Distraction osteogenesis
in cleft orthognathic surgery, 789
for mandibular reconstruction, 267
Diverticulectomy
endoscopic, 464-465, 464f
external, 463, 464f
Diverticulopexy, 463, 464f
Diverticulum, Zenker’s, 459-465, 460f-464f.
See also Zenker’s diverticulum.
Draf III approach, for cerebrospinal fl uid
leak arising from frontal sinus, 135
Drainage
of auricular hematoma, 1079-1080, 1080f
by cervical lymph nodes, predictability of,
686
of deep neck abscess, 675-677, 676f
of ear abscess, 1081-1082, 1082f
after facial fracture repair, 932
after infratemporal fossa surgery, 1018
Drainage (Continued)
lumbar
in anterior cranial base surgery, 985
for cerebrospinal fl uid leak, 135, 1057,
1058f, 1290
of middle ear. See Tympanostomy tube.
after orbital fracture repair, 942-943, 943f
of plunging ranula, 503-504, 503f
Dressings
after facial repair, 877, 932
for rhinoplasty, 817-818
for rhytidectomy, 853
Drill, microear, 1326, 1326f
Drill-out procedures, frontal sinus, 124-125,
124f-126f
Dural defect repair, temporalis fascial graft
in, 1363, 1363f, 1364, 1364f
Dural fl ap, in vestibular nerve section, 1401,
1401f, 1404, 1405f
Dural resection, in temporal bone resection,
1284
Dural sinus, temporal bone and,
relationship between, 1234f
Dysphagia
after cervical spine surgery, 717
after supracricoid partial laryngectomy
with cricohyoidoepiglottopexy, 406
from upper esophageal sphincter
dysfunction, 459, 460-462, 461f
Dysphonia
after laryngeal carcinoma endoscopic
surgery, 390
spasmodic, botulinum toxin injection for,
293
Dysplastic nevus syndrome, 722
E
Eagle’s syndrome, 195-197, 196f-197f
Ear
abscess of, 1081-1082, 1082f
anesthesia of
regional, 1077-1078, 1077f-1078f
topical, 1075-1077, 1076f
cancer on, surgery for, 728
caulifl ower, 1079
external
injury to, 881-882, 881f
regional anesthesia of, 1078, 1078f
topical anesthesia of, 1077
inner
anatomy of, 1377
medication delivery to, 1084-1087, 1086f
middle. See Middle ear entries.
protuberant, otoplasty for, 791-797,
792f-795f. See also Otoplasty.
reconstruction of
for microtia, 797-805, 798f-804f. See also
Microtia.
for skin cancer, 729, 730f
Ear drills, micro-, 1202, 1202f
Ear packing
after atresia repair, 1119-1120, 1120f
after canal wall reconstruction, 1110,
1110f
after exostoses removal, 1103, 1104, 1104f
after tympanoplasty, 1142-1143, 1143f,
1144f
Ecchymosis, lid, after external
ethmoidectomy, 104, 104f
Eccrine carcinoma, of head and neck, 725
Edema
cerebral, after petrosal approach to
cranial base tumor, 1042
Reinke’s, 303
Elderly person, thyroid cancer in, 542
Electrocautery
for anterior epistaxis, 3
suction, for adenoidectomy, 36, 36f
for tonsillectomy, 173, 176
Electromyography
botulinum toxin injection guided by, 294,
295f
during facial nerve decompression, 1388
in facial paralysis, 1259
in hemifacial spasm, 1386-1387
Electroneuronography
in facial nerve tumor, 1246
in facial paralysis, 1258-1259
in hemifacial spasm, 1386, 1387f
Electronystagmography fi stula test, in
perilymphatic fi stula, 1221, 1221f
Embolism
air
during acoustic neuroma surgery, 1315
during anterior cranial base surgery,
985
pulmonary, after petrosal approach to
cranial base tumor, 1042
Embolization
angiography with
for epistaxis, 9-10
for juvenile angiofi broma, 41, 41f, 42
of glomus tumor feeding vessel, 1323,
1323f
Embryology, of choanal atresia, 27
Emphysema, subcutaneous
after laryngeal surgery, 376
after optic nerve decompression, 959
after tracheostomy, 585
Empyema, subdural, in otitis media,
1234-1235
Encephalocele, 1359
after anterior cranial base surgery, 996
repair of, 1362, 1362f
EndoCDx brush, for laryngeal biopsy, 300,
300f
Endo-GIA stapler, in diverticulectomy, 464-
465, 464f
Endolymphatic sac surgery
complications of, 1408
for Ménière’s disease, 1394
for vertigo, 1396-1397, 1396f-1398f
Endonasal approach
advantages of, 1045
to cerebrospinal fl uid rhinorrhea,
1053-1059, 1057f, 1058f
to cranial base tumor, 1025, 1039-1040
to sella/parasellar areas, 1045-1051,
1046f-1050f
Endoscopic infratemporal fossa surgery,
1017-1018
Endoscopic microsurgery
for anterior glottic stenosis, 364-365, 365f
for laryngeal stenosis, 361
laser-based. See Laser surgery.
for subglottic stenosis, 367, 370, 371f
for tracheal stenosis, 607, 607f
Endoscopic percutaneous dilatational
tracheostomy, 585-593, 588f-591f

Index
I-9
Volume 1: pages 1-718
Volume 2: pages 719-1410
Endoscopic sinus surgery
for antrochoanal polyp, 128
bleeding during, 143-150
anatomy and, 143-144, 144f-145f
complications of, 149, 150f
patient selection and, 145
pearls and pitfalls in, 150
postoperative management of, 149,
149f
preoperative evaluation and planning
for, 145-146, 145f
surgical approaches to, 146-148,
146f-148f
cerebrospinal fl uid leak after, 131-136,
132f-135f
complications of, 131-150
ethmoid, 91-97
frontal sinus, 121-126
for juvenile angiofi broma, 43-44, 43f
maxillary, 51-56
orbital complications of, 139-142,
140f-143f
sphenoid, 111-112
video-assisted, 94
Endoscopic suture lateralization, in glottic
enlargement surgery, 313-314, 314f
Endoscopic thyroidectomy, 552
Endoscopy. See also Bronchoscopy;
Esophagoscopy; Laryngoscopy.
in cerebrospinal fl uid rhinorrhea. See
Cerebrospinal fl uid rhinorrhea,
endoscopic management of.
in cervical esophageal cancer, 477
in cervical spine surgery. See Cervical spine
surgery, endoscopic.
in laryngeal carcinoma, 422
laryngeal stenosis after, 358
in laryngeal trauma, 353
middle ear, 1088-1090, 1090f
nasal, diagnostic, 1-3
in oropharyngeal cancer, 285
rigid, in laryngotracheal stenosis, 605
in salivary duct calculi removal, 486, 486f,
487, 489, 489f
in tongue base and hypopharyngeal
tumor, 236
Endotracheal intubation
in anterior cranial base surgery, 986
in infratemporal fossa tumor surgery,
1002
in tracheal stenosis, 605
tracheal stenosis after, 603-604
Endotracheal tubes, nonfl ammable, 385
Enophthalmos
after cranial base reconstruction, 1067
in orbital blowout fracture, 938, 938f
Eosinophilic mucin rhinosinusitis, 3
Epidermoid tumor of temporal bone
overview of, 1339-1341, 1340f
preoperative evaluation of, 1343-1344
radiologic imaging of, 1341-1342, 1342f,
1342t, 1343
surgical management of
complications of, 1354-1355
decision-making for, 1344t, 1345-1346
pearls and pitfalls in, 1356
postoperative care after, 1353-1354
preauricular subtemporal infratemporal
approach in, 1351-1353,
1352f-1353f
Epidermoid tumor of temporal bone
(Continued)
transcochlear approach in, 1350
tympanomastoid exteriorization in,
1350-1351, 1350f-1351f
Epidural abscess, in otitis media, 1232-1233,
1233f
Epidural inlay graft, for skull defect repair,
133, 133f
Epiglottis, identifi cation of, in total
laryngectomy, 426, 427f
Epiglottopexy, 415, 417, 418f-419f
Epinephrine, lidocaine with. See Lidocaine
with epinephrine.
Epiphora
after blepharoplasty, 868
after medial maxillectomy and lateral
rhinotomy, 73
Epistaxis, 7-16
anatomy of, 7-9, 8f-10f
angiography with embolization for, 9-10
anterior, offi ce-based procedures for, 3
after cranial base reconstruction, 1066
differential diagnosis of, 3
hot water irrigation for, 9
management options for, 9-10, 11f
nasal packing for, 9
after optic nerve decompression, 959
septoplasty for, 17
surgical ligation for
approaches to, 11-14, 12f-14f
complications of, 14-16, 15f-16f
patient selection in, 10
pitfalls in, 16
postoperative care in, 14, 14f
preoperative evaluation and planning
in, 10-11
Esophageal speech, 431
Esophageal sphincter, upper
dysfunction of, 459-465, 460f-464f. See also
Zenker’s diverticulum.
manometry of, 462
Esophagography
barium
in cervical esophageal cancer, 475-476,
476f
of Zenker’s diverticulum, 461, 461f
contrast material for, 445
before esophagoscopy, 444, 445, 445f
Gastrografi n, in esophageal perforation,
448, 448f
in penetrating neck trauma, 452
Esophagoscope, cervical, in
tracheoesophageal puncture, 434, 435,
435f-436f
Esophagoscopy, 443-449
anatomy for, 443, 444f
anesthesia for, 446
complications of, 448-449, 448f
esophageal perforation from, 448, 448f
fl exible, 445-446, 447
historical background on, 443
indications for, 444
instruments for, 446, 446f
patient evaluation for, 444-445, 444f,
445f
pearls and pitfalls in, 449
in penetrating neck trauma, 452
postoperative care in, 447
rigid
Esophagoscopy (Continued)
versus fl exible, 445
technique of, 446, 447f
in tongue base and hypopharyngeal
tumor, 236
transnasal, 445-446, 447
transoral, 445
Esophagostomy, loop, 455, 455f
Esophagus
cervical. See Cervical esophagus.
perforation of
during esophagoscopy, 448, 448f
iatrogenic, 451-456, 452f-455f
reconstruction of, 479-481
with colonic interposition, 481
with free fl aps, 481
with gastric transposition and
pharyngogastric anastomosis, 480,
480f
postoperative management and
complications of, 482
thoracic, penetrating trauma to, 455, 455f
Esthesioneuroblastoma, 981, 981f
Estlander fl ap, for large lip tumor excision,
187-188, 191f
Ethmoid artery
anterior
anatomy of, 7-8, 8f, 143, 144f
ligation of
complications of, 15, 149
endoscopic, 14, 14f, 15, 146, 146f
external, 11-12, 12f, 15
with sphenopalatine artery ligation,
10
posterior
anatomy of, 8, 8f
in external ethmoidectomy, 103
ligation of, 146
Ethmoid bulla
anterior, 91
surgery of, 94-95
Ethmoid sinus
anatomy of, 91-92, 92f
hyperplasia of, 92
osteoma of, 99, 100f
posterior, orbital complications and, 140
roof of, cerebrospinal fl uid rhinorrhea
arising from, 133-134, 133f-135f, 1056
surgical approaches to, 100-102
tumor of, 99, 100
Ethmoid sinus surgery, endoscopic, 91-97
anesthesia and patient positioning for,
93
computer-assisted navigational technology
in, 94
indications for, 91
patient selection for, 92-93
pearls and pitfalls in, 97
postoperative management of, 96-97
preoperative evaluation for, 93
preparation for, 93-94, 94f
sphenoid sinus surgery with, 111-112
Ethmoidectomy
anterior, 94-95
external, 99-104
patient selection for, 99, 100f
pearls and pitfalls in, 104
postoperative management of, 104, 104f
preoperative evaluation for, 99-100
technique of, 102-104, 102f-104f

I-10
Index
Volume 1: pages 1-718
Volume 2: pages 719-1410
Ethmoidectomy (Continued)
intranasal, 101-102
in optic nerve decompression, 957, 958f
posterior, 95-96, 96f
Eustachian tube
cerebrospinal fl uid leak through. See
Cerebrospinal fl uid rhinorrhea.
dysfunction of, tympanostomy tube
placement for, 1125-1126, 1126f
in middle fossa approach to petrous
carotid artery, 1022f, 1031
Eutectic mixture of local anesthetics
(EMLA)
in eardrum, 1077
in external ear, 1077
EXIT (ex utero intrapartum treatment)
procedure, for ranula, 501, 502f
Exophthalmos, after anterior cranial base
surgery, 996
Exostoses, of external auditory canal,
1099-1106, 1100f
complications of, 1105
pearls and pitfalls in, 1105-1106
postoperative management of, 1104-1105
preoperative planning for, 1100-1101
surgical management of
patient selection for, 1100
techniques for, 1101-1104, 1103f-1104f
External auditory canal
anatomy of, 1272, 1273f
atresia of, surgical repair of, 1113-1122
for acquired atresia, 1120-1121,
1120f-1121f
complications of, 1121-1122
for congenital atresia, 1116-1120,
1116f-1120f
patient selection for, 1113, 1114f, 1114t,
1115
pearls and pitfalls in, 1122
postoperative management after, 1121
cancer of, 1271-1272. See also Temporal
bone carcinoma.
creation of, in atresia repair, 1116-1117,
1117f
exostoses and osteomas of, 1099-1106,
1100f
complications of, 1105
pearls and pitfalls in, 1105-1106
postoperative management of,
1104-1105
preoperative planning for, 1100-1101,
1101f
surgical management of
patient selection for, 1100
techniques for, 1101-1104,
1102f-1104f
foreign body in, 1093-1097
pearls and pitfalls in, 1097
postoperative management of, 1097
preoperative planning for, 1094
removal of, 1094-1097, 1095f-1096f
types of, 1093-1094
four-quadrant block of, 1077, 1078f
keratosis obturans and cholesteatoma of,
1083, 1107-1111, 1108f-1109f
complications of, 1110
pearls and pitfalls in, 1110-1111
postoperative management of, 1110
preoperative evaluation of, 1109
surgical management of
External auditory canal (Continued)
patient selection for, 1109
techniques for, 1109-1110,
1109f-1110f
lymphatic drainage of, 1272
mass in, biopsy of, 1082-1084, 1083f, 1083t
removal of, in lateral temporal bone
resection, 1279-1282, 1279f-1282f
restenosis of, after atresia repair,
1121-1122
topical anesthesia of, 1077
External ear
injury to, 881-882, 881f
regional anesthesia of, 1078, 1078f
topical anesthesia of, 1077
External meatus, creation of, in atresia
repair, 1118-1119, 1119f
Extraocular muscles, 936f, 949f
injury to, during lower lid blepharoplasty,
869
Eye
dry, after blepharoplasty, 868
injuries to, 878-879, 879f, 880f
orbit of. See Orbit; Orbital entries.
Eye reanimation, 973-977
brow-lift in, 974
lower eyelid procedures in, 975-976,
976f-977f
patient selection for, 973
pearls and pitfalls in, 977
upper eyelid procedures in, 974-975,
974f-976f
Eyelid
avulsion injuries to, 878, 879f, 880f
cancer on, surgery for, 727-728
ecchymosis of, after external
ethmoidectomy, 104, 104f
laxity of, “snap test” for, 858
paralyzed, reanimation for, 973-977,
974f-977f
plastic surgery on. See Blepharoplasty.
ptosis of, blepharoplasty and, 858
repair of, 729
Eyelid distraction test, 858
F
Face lift. See Rhytidectomy.
Facial artery
preservation of, in marginal
mandibulectomy, 256
in transcervical submandibular gland
excision, 508
Facial cleft. See Cleft(s), facial.
Facial degloving procedure
in anterior cranial base surgery, 984, 984f
medial maxillectomy and, 73, 74f
Facial fracture. See also specifi c anatomic
location, e.g., Nasal fracture.
mandibular, 885-902. See also Mandibular
fracture.
middle and upper, 905-932. See also
Midfacial and upper facial fracture.
Facial myokymia, 1386, 1386t
Facial nerve
aberration of, in middle ear
reconstruction, 1180-1181, 1180f,
1181f
anatomy of, 684, 1261f
in atresia repair, 1117, 1117f
Facial nerve (Continued)
buccal branches of, 537, 538f
decompression of. See Facial nerve
decompression.
dehiscence and displacement of, during
middle ear surgery, 1205-1206, 1206f
dissection of
in glomus jugulare tumor surgery, 1331-
1332, 1332f
in subtotal temporal bone resection,
1283, 1283f
superfi cial lobe parotidectomy with,
514-515, 514f
total parotidectomy with, 517-519,
518f-519f
frontal branches of
anatomy of, 1028f
in anterior transfacial infratemporal
fossa surgery, 1014, 1014f
identifi cation of
in mastoidectomy, 1170, 1170f
in superfi cial lobe parotidectomy, 514,
514f
injury to
assessment of, 1257-1259
during canal wall reconstruction, 1110
during cochlear implant surgery,
1382-1383
during exostoses removal, 1105
histopathophysiologic classifi cation of,
1257
during infratemporal fossa surgery,
1019
during labyrinthectomy, 1408
during mastoidectomy, 1175
operative, 1260
during rhytidectomy, 855
during superfi cial lobe parotidectomy,
516
after temporal bone fracture
medial to geniculate ganglion with
useful hearing, 1371-1373, 1373f
medial to geniculate ganglion without
useful hearing, 1371, 1373f
at or distal to geniculate ganglion,
1370-1371, 1371f-1372f
traumatic, 879, 880f
during vestibular nerve section, 1409
mastoid segment of, identifi cation of,
1261, 1262f
monitoring of, during mastoidectomy,
1165
preservation of
in fi rst branchial cleft remnant excision,
650, 650f, 651, 651f
in middle fossa approach to petrous
carotid artery, 1027-1028, 1028f
repair of, 521-522, 521f-522f, 879
anastomotic techniques in, 1266-1267,
1370-1371, 1371f
donor sites for, 879
greater auricular nerve graft for,
1248-1249, 1248f, 1250f, 1251f,
1268, 1371, 1372f
in internal auditory canal, 1371
method of, and extent of resection,
1249-1250, 1249f, 1250f
primary, 1267-1268
principles of, 1255
sural nerve graft in, 1252, 1252f, 1268

Index
I-11
Volume 1: pages 1-718
Volume 2: pages 719-1410
Facial nerve (Continued)
after temporal bone resection,
1286-1287, 1287f
temporal branches of, in anterior cranial
base surgery, 987
translocation of
in postauricular (transtemporal)
infratemporal fossa surgery, 1009,
1013f
in total petrosectomy, 1038
tumor of
House-Brackmann grading system for,
1243, 1243t
malignant, 1241
management options for, 1244-1245
primary, 1241-1243, 1242f
radiologic imaging of, 1243, 1244f
surgical management of
combined middle fossa–transmastoid
approach in, 1251-1252, 1251f
complications of, 1255
decompression in, 1250-1251
greater auricular nerve graft in,
1248-1249, 1248f, 1250f, 1251f
middle fossa approach in, 1250-1251,
1250f-1251f
patient positioning in, 1247, 1247f
patient selection for, 1243-1246,
1243t
pearls and pitfalls in, 1255-1256
postoperative care in, 1253-1254,
1253f, 1254f
preoperative planning for, 1246-1247
retrosigmoid approach in, 1252
stereotactic radiosurgery in, 1246,
1252-1253, 1253f
sural nerve graft in, 1252, 1252f
techniques in, 1247-1253
translabyrinthine approach in,
1249-1250, 1249f-1250f
transmastoid approach in, 1247-1248,
1248f
Facial nerve decompression
in Bell’s palsy, 1259
complications of, 1268-1269
for facial nerve tumor, 1250-1251
for hemifacial spasm, 1385-1392
closure methods after, 1391
monitoring during, 1388
nerve exposure in, 1388-1390,
1389f-1390f
patient positioning and preparation in,
1387, 1388f
patient selection in, 1385-1386, 1386t
pearls and pitfalls in, 1392
postoperative management of, 1391
preoperative evaluation in, 1386-1387,
1387f
surgical exposure in, 1388, 1389f
technique of, 1390-1391, 1390f
middle fossa approach to, 1263-1266,
1264f-1267f, 1269
patient selection for, 1257-1261
pearls and pitfalls in, 1269
postoperative management of, 1268
preoperative planning for, 1261
for surgically induced facial paralysis, 1260
translabyrinthine approach to, 1263
transmastoid approach to, 1261-1263,
1262f-1263f, 1268
Facial nerve graft, hypoglossal-, for facial
reanimation, 840
Facial nerve–hypoglossal anastomosis, 522,
522f
Facial paralysis, 1257-1269
after acoustic neuroma surgery, 1315
in Bell’s palsy, 1259
differential diagnosis of, 1258t
electrical testing in, 1257-1259
eye reanimation in patient with, 973-977,
974f-977f
after facial nerve tumor surgery,
1253-1254, 1253f, 1254f
after glomus tumor surgery, 1334
in hemangioma, 1242
in herpes zoster oticus, 1259
in infratemporal fossa tumor, 998
after middle fossa vestibular nerve section,
1409
neoplasms causing, 1261
operative nerve injury causing, 1260
in otitis media, 1260-1261
in parotid gland cancer, 512, 512f
in Ramsay Hunt syndrome, 1259
reanimation for. See Facial reanimation.
after temporal bone fracture, 1367-1368
Facial reanimation, 839-843
complications of, 842-843
dynamic
hypoglossal-facial jump graft for, 840
options for, 839-840
patient selection for, 839
pearls and pitfalls in, 843
postoperative care in, 841-842
preoperative planning for, 839-840
static
of lower lip, 841, 841f, 842f
for nasal obstruction, 841
options for, 840
of smile, 840-841, 841f
surgical techniques for, 840-841
Facial recess
drilling of, in mastoidectomy, 1170-1171,
1170f, 1171f
opening of
in facial nerve decompression surgery,
1262, 1262f
in lateral temporal bone resection,
1281, 1281f
Facial ridge, high, 1171, 1172f
Facial soft tissue injuries, 871-884
evaluation of, 871
stabilization of, 871
treatment of
anesthesia for, 875-876
by location of injury, 878-884, 879f-883f
preparation for, 871-872
scar revision in, 878
suture materials for, 876-877, 877t
by type of injury, 872-875, 873f, 875f
wound care after, 877-878
Facial spasm. See also Hemifacial spasm.
differential diagnosis of, 1386, 1386t
Facial translocation approach, in
infratemporal fossa surgery, 1009,
1014-1015, 1014f-1016f
Facial vein, in transcervical submandibular
gland excision, 506, 507f
Facies, adenoid, 33
Famciclovir, for Bell’s palsy, 1259
Farrior stapes rasp, 1200
Fascial fl ap
in postauricular (transtemporal)
infratemporal fossa surgery, 1009,
1013f
temporoparietal, 758-759, 760f
for cranial base reconstruction, 1064,
1064f
Fascial graft
in anterior cranial base reconstruction, 990
in atresia repair, 1118, 1118f
in dural defect repair, 1363, 1363f, 1364,
1364f
for sealing of perilymphatic fi stula, 1225,
1226f
Fasciitis, cervical, necrotizing, 676
Fasciocutaneous fl ap
lateral arm, 741-742, 742f
parascapular, 741
radial forearm, 739-740, 740f
for nasal lining, 828, 831f
for pharyngectomy defect, 748, 748f
scapular, 741, 741f
Fat injection, for vocal fold augmentation,
319, 320-321, 321f
Fat obliteration
in acoustic neuroma surgery, 1305, 1305f
in endonasal skull base reconstruction,
993, 993f, 994f
in frontal sinusotomy, 115-117, 116f-117f
in skull defect repair, 134-135, 135f
FDG-PET, in parapharyngeal space tumor,
661
Feeding tube, after supracricoid partial
laryngectomy with
cricohyoidoepiglottopexy, 406
Fibrofascial tissue, for sealing of
perilymphatic fi stula, 1224-1225, 1225f
Fibrous histiocytoma, malignant, of head
and neck, 726
Fibrous mass, of vocal fold, 303-304
Fibrovascular polyp, of cervical esophagus,
474
Fibroxanthoma, atypical, 726
Fibular fl ap, 742-744, 744f
for mandibular reconstruction, 273,
274f
Fine-needle aspiration biopsy (FNAB),
629-633
in children, 630
computed tomography–guided, 633
equipment for, 630-631, 631f
overview of, 629-630
of parotid gland tumor, 512, 633
pearls and pitfalls in, 633
preparation for, 630-632, 631f-632f
of prestyloid parapharyngeal space tumor,
528
of salivary gland tumor, 633
specimen handling in, 632-633
technique of, 632, 632f
of thyroglossal duct cyst, 638
of thyroid neoplasm, 544-545, 630, 631t
ultrasound-guided, 632-633
First bite syndrome, 526, 531, 669
Fisch glomus tumor classifi cation, 1320,
1320t
Fissure(s). See also Laryngofi ssure.
of Santorini, 1272, 1274f
superior orbital, 908

I-12
Index
Volume 1: pages 1-718
Volume 2: pages 719-1410
Fistula
branchial cleft. See Branchial cleft
remnants.
chyle, after neck dissection, 704, 705
laryngocutaneous, after laryngofi ssure,
338
after laryngotracheal separation, 600
oral-antral, 63-66, 64f-66f
oral-nasal, after hard palate cancer
surgery, 215
palatal, repair of, 785-787
perilymphatic. See Perilymphatic fi stula.
pharyngocutaneous
after arytenoid adduction, 333
after lateral pharyngotomy, 239-240
of piriform sinus, 653, 655f
tracheocutaneous, after tracheostomy,
617-621, 618f-620f
tracheoesophageal
for speech rehabilitation. See
Tracheoesophageal puncture.
after tracheostomy, 585
during tracheostomy, 583
Fistula test, in perilymphatic fi stula, 1221,
1221f
Five-cornered transcolumellar inverted-V
incision, for rhinoplasty, 808, 808f,
809f
Flap. See also specifi c anatomic site and type,
e.g., Free fl ap.
Abbé, in large lip tumor excision, 188,
192f
Estlander, for large tumor of the lip,
187-188, 191f
ischemia of, after temporal bone
resection, 1291
Karapandzic, for large tumor of the lip,
188-189, 192f
necrosis of
after rhytidectomy, 855
scalp, 1019, 1020f, 1065-1066
after skin cancer surgery, 734-735
after superfi cial lobe parotidectomy,
516
separation of, after temporal bone
resection, 1291
Flow cytometry, 630
Fluorescein, intrathecal, in cerebrospinal
fl uid rhinorrhea, 131, 133, 1054
Fluoroscopy, in laryngeal stenosis, 361
5-Fluorouracil cream, for skin cancer, 721
FNAB. See Fine-needle aspiration biopsy
(FNAB).
Fomon scissors, in rhinoplasty, 810, 811f
Footplate. See Stapedial footplate.
Foramen magnum, neoplasms at, 1070,
1070f
Foramen of Huschke, 1272, 1274f
Forced duction test, in orbital fl oor fracture,
940, 941f
Forceps
esophagoscopy, 446f
microbipolar, 1326, 1326f
Forehead
cancer on, 728, 732
subperiosteal abscess of, 118, 118f
Forehead fl ap
for nasal lining, 827-828, 829f-830f
for nasal reconstruction, 731-732, 734f
for nasal skin coverage, 835-836
Foreign body
bronchoscopic removal of, 573-574, 573f,
573t, 574f
in external auditory canal, 1093-1097
pearls and pitfalls in, 1097
postoperative management of, 1097
preoperative planning for, 1094
removal of, 1094-1097, 1095f-1096f
types of, 1093-1094
Forestier’s disease, 710, 712f
Four-quadrant canal block, 1077, 1078f
Fovea ethmoidalis, 99-100
Fracture. See also specifi c anatomic location,
e.g., Nasal fracture.
mandibular, 885-902. See also Mandibular
fracture.
midfacial and upper facial, 905-932. See
also Midfacial and upper facial
fracture.
orbital. See Orbital fracture.
temporal bone, 1367-1375. See also
Temporal bone, fracture of.
Free fl ap, 739-751
anterolateral thigh, 745-746, 746f
for pharyngectomy defect, 746f, 748
for cheek and nasal defects, 821-822,
823f-825f
complications of, 482
for cranial base reconstruction, 1064,
1065f
for esophageal reconstruction, 481
fi bular, 742-744, 744f
for glossectomy defects, 744f, 747-748
for head and neck reconstruction
patient selection and preoperative
evaluation for, 739-746
pearls and pitfalls in, 750-751
postoperative management of, 749-750,
750f
surgical approaches in, 746-749
iliac crest, 744-745, 745f
jejunal, 745
disadvantages of, 745
monitor loop of, 750, 750f
for pharyngectomy defect, 748
after total laryngopharyngectomy, 470,
471f
for large soft tissue defects, 1008, 1011f
lateral arm, 741-742, 742f
after lateral pharyngotomy, 239
latissimus dorsi
for cranial base reconstruction, 1064,
1065f
for skull base defects, 749, 749f
for mandibular reconstruction, 224, 250,
251f, 252, 273, 274f, 740f, 744f,
746-747
for maxillectomy defects, 743f, 749
for midface and maxillectomy defects,
743f, 749
monitoring of, 749-750
for nasal lining, 828, 831f, 832f
after orbital exenteration, 963, 964f, 965
for palatal reconstruction, 86, 209,
213-214, 743f, 749
parascapular, 741
for pharyngectomy defect, 746f, 748, 748f
radial forearm, 739-740, 740f
for nasal lining, 828, 831f
for pharyngectomy defect, 748, 748f
Free fl ap (Continued)
after total laryngopharyngectomy, 470,
471f
for reconstruction after temporal bone
resection, 1286
for reconstruction of extended
maxillectomy with orbital
exenteration, 87-88, 87f-88f
rectus abdominis, 742, 743f
in orbital exenteration, 964f, 965
scapular, 741, 741f
after segmental mandibulectomy, 273
septal pivot, for nasal lining, 828, 832f
for skull base defects, 749, 749f
for skull defect repair, 133-134, 133f-135f,
1056
for subtotal glossectomy, 223
venous outfl ow obstruction and
restoration for, 749-750, 750f
Frey’s syndrome, 495-498, 496f, 497f, 516
Frontal lobe dura elevation, in anterior
cranial base surgery, 988-989, 988f
Frontal sinus
ablation of, 118, 118f
anatomy of, 121, 122f
cerebrospinal fl uid rhinorrhea arising
from, 135, 1057
fracture of
displacement of, 911-912, 927,
927f-930f, 929
preoperative evaluation of, 910-912,
911f
surgical repair of, 923, 925f-931f,
927-930
treatment of, 911-912, 911f
osteoma of, 113, 114f
pneumatization of, 113
steroid injection of, 4
trephination of, 114-115, 115f, 122-123,
123f
uncinate attachment to, 121, 122f
Frontal sinus drill-out procedures, 124-125,
124f-126f
Frontal sinus surgery
endoscopic, 121-126
advanced, 123-125, 124f-126f
basic, 123
complications of, 125
patient selection for, 121
pearls and pitfalls in, 126
postoperative care in, 125
preoperative planning for, 121-122
techniques of, 122-125
trephination as adjunct to, 122-123,
123f
external, 113-119
complications of, 118-119
patient selection for, 113
pearls and pitfalls in, 119
preoperative planning for, 113, 114f,
115f
techniques of, 114-118
Frontal sinusitis, 113, 114f, 115f, 121
Frontal sinusotomy with fat obliteration,
115-117, 116f-117f
Frontoethmoidectomy, Lynch’s, 117-118,
118f
Functional endoscopic examination of
swallowing (FEES), 461, 461f
Fungal infection, of orbit, 961

Index
I-13
Volume 1: pages 1-718
Volume 2: pages 719-1410
Furlow palatoplasty, 778-780, 779f
revision, for velopharyngeal
incompetence, 785
Furosemide, during temporal bone
resection, 1279
Furuncle, ear, incision and drainage of,
1081, 1082
G
Galeopericranial fl ap, in anterior cranial
base reconstruction, 990-991, 1061-1062,
1062f-1063f
Gastric transposition and pharyngogastric
anastomosis, esophageal reconstruction
with, 480, 480f
Gastroesophageal refl ux disease
laryngeal stenosis in, 360, 360f
tracheal stenosis in, 604
Gastro-omental fl ap, for esophageal
reconstruction, 481
Gelfoam
in myringoplasty, 1136-1137, 1138f
packing with, in medial maxillectomy and
lateral rhinotomy, 70-71
in type IV tympanoplasty, 1158
Gelfoam/Gelfi lm, for skull defect repair,
134, 1056
Gelfoam/Surgifoam, for vocal fold
augmentation/injection, 319
Geniculate ganglion, 1308, 1308f
facial nerve injury at or distal to,
1370-1371, 1371f-1372f
facial nerve injury medial to
with useful hearing, 1371-1373, 1373f
without useful hearing, 1371, 1373f
hemangioma of, 1242-1243, 1244f. See also
Facial nerve, tumor of.
Gentamicin, intratympanic, 1084-1087, 1086f
Gingivobuccal sulcus incision, 45, 47f, 60,
60f, 72, 74f, 109, 110f
Glasscock-Jackson glomus tumor
classifi cation, 1320, 1320t
Glenoid fossa, identifi cation of, in atresia
repair, 1116, 1117f
Glenoid fossa osteotomy
in middle fossa approach to petrous
carotid artery, 1028, 1029f
in preauricular (subtemporal)
infratemporal fossa surgery, 1004,
1005f
Globe, open injuries to, with orbital
fracture, 939
Glomus jugulare tumor, 1319
Fisch type C2 or greater, 1330-1333,
1330f-1333f
Fisch types C1 and C2, 1328f-1329f,
1329-1330
Glomus tumor, 664, 1319-1335
angiography in, 1323, 1323f, 1324, 1324f
arising from jugular bulb, 1319
surgical management of, 1328-1333,
1328f-1333f
arising from middle ear, 1319
surgical management of, 1325-1326,
1326f
carotid body. See Carotid body tumor.
classifi cation of, 1320, 1320t
computed tomography in, 1322, 1322f
differential diagnosis of, 1320-1321
Glomus tumor (Continued)
familial, 666, 1319
jugulotympanic, 1319
surgical management of, 1326-1327,
1327f
magnetic resonance angiography in,
1322-1323, 1323f
magnetic resonance imaging in, 1322,
1322f
malignant, 1319
radiation therapy for, 1321
secreting, 1322
stereotactic radiosurgery for, 1324-1325,
1325f
surgery for
complications of, 1334-1335
incisions in, 1328, 1328f
infratemporal fossa dissection in,
1330-1331, 1331f
neck dissection in, 1328, 1328f, 1330
patient selection for, 1320-1321, 1321f
pearls and pitfalls in, 1335
postoperative care in, 1333-1334
preoperative planning for, 1322-1324,
1322f-1324f
techniques in, 1325-1333
transtemporal dissection in, 1328-1329,
1329f, 1331-1332, 1331f, 1332f
tumor isolation and removal in,
1329-1330, 1329f, 1332-1333,
1332f-1333f
temporal bone, 1319-1335
Glomus tympanicum tumor, 1083f, 1319,
1325-1326, 1326f
Glomus vagale tumor
anatomy of, 664
excision of, 668, 668f
Glossectomy
complications of, 227
defects after, free fl ap for, 744f, 747-748
partial, 218-223, 219f-222f
preoperative planning for, 218-220,
219f-220f
technique of, 220-223, 220f-221f
pearls and pitfalls in, 227
postoperative management of, 226-227
total, 223-226, 223f-225f
approach to, 224-225
laryngectomy and, 225
patient selection for, 223
preoperative planning for, 223-224,
223f
technique of, 224f-225f, 225-226
Glottic carcinoma. See Laryngeal cancer.
Glottic enlargement surgery, 311-316
patient selection for, 311
pearls and pitfalls in, 315-316
postoperative management of, 314-315
preoperative evaluation for, 311-312
preoperative planning for, 312
surgical approaches in, 312-314, 313f-315f
Glottic insuffi ciency
causes of, 318
medialization laryngoplasty and arytenoid
adduction for, 329-333. See also
Laryngoplasty, medialization.
vocal fold augmentation/injection for. See
Vocal fold augmentation/injection.
Glottic lesions, premalignant, 381, 381f,
382f
Glottic stenosis
anterior, surgical treatment of, 363-367,
365f-368f
posterior, 314, 315f
surgical treatment of, 367, 369f-370f
after recurrent respiratory papillomatosis
surgery, 327
Glottis, anatomy and physiology of, 349,
350f, 357
Goiter
multinodular, 551
substernal
computed tomography in, 545, 545f
surgery for, 551-552
Gold weight procedure
in eye reanimation, 974-975, 974f-976f
for postoperative facial paralysis,
1253-1254, 1253f, 1254f
Goode T tube, 1127, 1127f
Gore-Tex, for medialization laryngoplasty,
330-331, 331f
Gradenigo’s syndrome, 1025-1026, 1025f,
1276
Granulation tissue
in middle ear, management of, 1140-1141
after skin cancer surgery, 735
after stapes surgery, 1207
after tracheal stenosis surgery, 613
after tracheostomy, 585
Granuloma
cholesterol, of temporal bone. See
Cholesterol granuloma of temporal
bone.
after laryngeal carcinoma endoscopic
surgery, 390
Tefl on, 318f
vocal fold, botulinum toxin injection for,
293-294, 294f
Granulomatosis, Wegener’s
laryngeal stenosis in, 359, 359f
steroid injection of frontal sinus in, 4
subglottic stenosis in, 604
Granulomatous disease, tracheal stenosis in,
604
Graves’ disease, 551
Graves’ orbitopathy, orbital decompression
for, 947-953, 948f. See also Orbital
decompression.
Grommet tube, after tympanocentesis, 1128,
1128f
Gunshot wounds
facial soft tissue injuries in, 874-875
laryngeal, 350, 351f
Gustatory sweating, 495-498, 496f, 497f,
516
H
Habit spasms, 1386t
Haddad-Bassagasteguy fl ap
for endonasal skull base reconstruction,
994
harvesting of, 992
for skull defect repair, 134, 134f-135f,
1056
Hard palate, cancer of, 205-215
biopsy of, 207-208
metastasis of, 207, 208, 208f
radiation therapy for, 207
staging of, 207

I-14
Index
Volume 1: pages 1-718
Volume 2: pages 719-1410
Hard palate, cancer of (Continued)
surgery for
anatomy in, 205
complications of, 215
neck dissection in, 211
patient selection in, 205-207, 206f
pearls and pitfalls in, 215
postoperative management of, 214-215
preoperative planning in, 207-209, 208f
speech rehabilitation after, 211-214,
213f-214f
techniques in, 209-214, 209f-214f
types of, 205, 206f
Hardy self-retaining speculum, in sphenoid
sinus surgery, 110, 110f
Harmonic scalpel
for cervical incision, 547
for tonsillectomy, 172-173
Head and neck. See also Neck.
cancer of
extracapsular spread of, 679, 680f
staging of, 679, 680f, 688, 689f
mass in, fi ne-needle aspiration biopsy of,
629-633
skin cancer of, 719-736. See also Skin
cancer.
Head holder, Mayfi eld horseshoe, 986, 1247,
1247f
Headache
after acoustic neuroma surgery, 1316
after facial nerve decompression, 1391
after vestibular nerve section, 1409
Hearing aid, bone-anchored, 1209-1217,
1210f
for aural atresia, 1115, 1116
in children, 1215-1216
drilling of fi xture site for, 1211-1213,
1212f
insertion of, 1214-1215, 1214f, 1215f
patient selection for, 1210
pearls and pitfalls in, 1216-1217
planning of skin fl ap for, 1210-1211, 1211f
postoperative management of, 1216
preoperative evaluation for, 1210
soft tissue removal for, 1213-1214, 1213f
surgical approach for, 1210-1216
Hearing assessment. See Audiologic testing;
Audiometry.
Hearing loss
in acoustic neuroma, 1299, 1299f
after acoustic neuroma surgery, 1315
in cerebrospinal fl uid leak, 1360
in children, progressive versus stable, 1179
conductive
assessment of, 1148, 1149f, 1178, 1179
in middle ear malformations, 1177
after endolymphatic sac surgery, 1408
after facial nerve tumor surgery, 1255
after glomus tumor surgery, 1334
in infratemporal fossa tumor, 998
after intratympanic gentamicin, 1084
ossicular chain reconstruction for,
1147-1162. See also Ossicular chain
reconstruction.
in otosclerosis, 1189-1190, 1190f
after posterior semicircular canal
occlusion, 1408
sensorineural
after mastoidectomy, 1175
in perilymphatic fi stula, 1222
Hearing loss (Continued)
sudden, intratympanic dexamethasone
for, 1084, 1085, 1086
in tympanic membrane perforation, 1134
Hemangioma
of facial nerve, 1242-1243, 1244f. See also
Facial nerve, tumor of.
macroglossia and, 162, 164f
Hematoma
auricular, 1079-1081, 1080f
after glomus tumor surgery, 1334
after neck dissection, 705
orbital, 950
after orbital exenteration, 965
after otoplasty, 795
after prestyloid parapharyngeal space
tumor excision, 530
retrobulbar, after blepharoplasty, 869
after rhytidectomy, 855
septal, after septoplasty, 24
after skin cancer surgery, 734
after superfi cial lobe parotidectomy, 516
after thyroid surgery, 553
Hemicoronal scalp incision
for preauricular (subtemporal)
infratemporal fossa surgery, 1002,
1002f
with Weber-Fergusson incision, in anterior
transfacial approach, 1009, 1014,
1014f
Hemifacial spasm
differential diagnosis of, 1386, 1386t
facial nerve decompression for, 1385-1392
closure methods after, 1391
monitoring during, 1388
nerve exposure in, 1388-1390,
1389f-1390f
patient positioning and preparation in,
1387, 1388f
patient selection in, 1385-1386, 1386t
pearls and pitfalls in, 1392
postoperative management of, 1391
preoperative evaluation in, 1386-1387,
1387f
surgical exposure in, 1388, 1389f
technique of, 1390-1391, 1390f
Hemiglossectomy, 222. See also Glossectomy,
partial.
Hemilaryngectomy. See Laryngectomy,
vertical partial.
Hemochromatosis, neonatal, lip biopsy in,
491
Hemorrhage
during acoustic neuroma surgery, 1315
during endoscopic sinus surgery, 143-150
intracranial, after temporal bone
resection, 1291
after juvenile angiofi broma surgery, 48
after laryngeal carcinoma endoscopic
surgery, 390
in midfacial and upper facial fracture, 905
from nose. See Epistaxis.
after percutaneous dilatational
tracheostomy, 592
retrobulbar, after endoscopic sinus
surgery, 139-140, 140f
after septoplasty, 24
after tonsillectomy, 178-179
after tracheostomy, 584
during tracheostomy, 583
Hemostasis
for facial soft tissue injuries, 871-872
using electrocautery, for tonsillectomy,
173, 176
Herpes zoster oticus, facial paralysis in, 1259
Hiatus semilunaris, 92
Histiocytoma, malignant fi brous, of head
and neck, 726
HIV/AIDS, skin cancer in, 723
Hoarseness
in laryngeal carcinoma, 382, 383
after laryngeal carcinoma endoscopic
surgery, 390
in patients with cleft palate, 780, 780t
“Hockey stick” incision, for neck dissection,
691, 692f
Hook, right-angled, for foreign body
removal from ear, 1095, 1096f
Hot water irrigation, for epistaxis, 9
House-Brackmann grading system, for facial
nerve tumor, 1243, 1243t
Human immunodefi ciency virus (HIV)
infection, skin cancer in, 723
Human papillomavirus infection
chronic, skin cancer in, 723
recurrent respiratory papillomatosis from,
323
vaccine for, 327
Hurd retractors, in styloid process surgery,
196, 196f
Huschke, foramen of, 1272, 1274f
Hyaluronic acid, for vocal fold
augmentation/injection, 319
Hydrocephalus
high-pressure
after facial nerve decompression,
1391
risk of, in patient with cerebrospinal
fl uid rhinorrhea, 1057-1058,
1058f
after temporal bone resection, 1291
otitic, 1236
Hydroxyapatite
for ossicular chain prosthesis, 1151, 1152f,
1155, 1156f
for vocal fold augmentation/injection,
319
Hyoepiglottic ligament, in total
laryngectomy, 426, 427f
Hypercalcemia, in hyperparathyroidism, 559
Hyperglycemia, after anterior cranial base
surgery, 995
Hyperhidrosis
assessment tools for, 496, 496t
gustatory, 495-498, 496f, 497f
Hypernasality, in patients with cleft palate,
780, 780t
Hyperparathyroidism, parathyroidectomy
for, 559-564. See also Parathyroidectomy.
Hyperplastic polyp, of cervical esophagus,
474
Hypersomnolence, in obstructive sleep
apnea, 151, 152f
Hypertension, intracranial
after facial nerve decompression, 1391
risk of, in patient with cerebrospinal fl uid
rhinorrhea, 1057-1058, 1058f
after temporal bone resection, 1291
Hyphema, as contraindication to orbital
fracture repair, 939

Index
I-15
Volume 1: pages 1-718
Volume 2: pages 719-1410
Hypocalcemia
after anterior cranial base surgery, 995
after neck dissection for thyroid cancer,
552-553
after thyroid surgery, 554-555
Hypoglossal nerve
anatomy of, 684
injury to, during tongue reduction
surgery, 166-167
in radical neck dissection, 696, 696f
in transcervical submandibular gland
excision, 507-508
Hypoglossal-facial jump graft, for facial
reanimation, 840
Hypoglossal–facial nerve anastomosis, 522,
522f
Hypomagnesemia, after anterior cranial base
surgery, 995
Hyponasality, in patients with cleft palate,
780, 780t
Hyponatremia, after anterior cranial base
surgery, 994
Hypoparathyroidism, after thyroid surgery,
554
Hypopharynx
anatomy and physiology of, 467
cancer of
cervical metastasis of, 469
chemoradiotherapy for, 467
lateral pharyngotomy for, 235-240. See
also Pharyngotomy, lateral.
pharyngectomy for, 467-471. See also
Pharyngectomy.
penetrating trauma to, 451-456
complications of, 456
evaluation and diagnosis of, 451-452,
452f
iatrogenic, 451-452
medical treatment of, 453
pearls and pitfalls in, 456
postoperative management of, 455-456
surgical treatment of, 453-455,
453f-455f
Hypophosphatemia, after anterior cranial
base surgery, 995
Hypothyroidism, after thyroidectomy, 555
I
Iliac crest bone graft, for reconstruction at
cleft site, 787, 787f
Iliac crest free fl ap, 744-745, 745f
Imiquimod, for skin cancer, 721
Immunophenotyping, 630
Immunosuppressed patient, skin cancer in,
723
Impaction sutures, in supracricoid partial
laryngectomy with
cricohyoidoepiglottopexy, 405-406,
407f
Implant
cochlear. See Cochlear implant.
complications of, after medialization
laryngoplasty, 332-333
material used in
for medialization laryngoplasty, 330-331,
331f
for orbital reconstruction, 943
for vocal fold augmentation/injection,
319, 319t
Incision(s)
apron, for total laryngectomy, 423, 424f
Blair, for superfi cial lobe parotidectomy,
513, 514f
brow, for superior orbital rim fracture
repair, 918
buccogingival, 269, 270f
cervical, for thyroid surgery, 546-547, 547f
for cervical spine surgery, 713, 713f,
715-716, 716f
coronal
for Le Fort III fracture repair, 913-914,
913f, 914f
for orbital rim fracture repair, 914f, 918
for cricopharyngeal myotomy, 460, 462
for external ethmoidectomy, 102-104, 102f
for frontal sinus trephination, 114, 115f
for frontal sinusotomy with fat
obliteration, 116, 116f
gingivobuccal sulcus, 45, 47f, 60, 60f, 72,
74f, 109, 110f
for glomus tumor surgery, 1328, 1328f
hemicoronal scalp
for preauricular (subtemporal)
infratemporal fossa surgery, 1002,
1002f
with Weber-Fergusson incision, in
anterior transfacial approach, 1009,
1014, 1014f
“hockey stick,” for neck dissection, 691,
692f
for inferior maxillectomy, 210-211, 211f
intercartilaginous, for medial
maxillectomy, 74f
for juvenile angiofi broma surgery, 44-45,
44f
for laryngeal trauma surgery, 353, 353f
for laryngofi ssure, 336, 336f
lateral nasal, for orbital rim fracture
repair, 918
for lateral pharyngotomy, 237, 237f
for lateral temporal bone resection,
1279-1280, 1279f, 1280f
for lip cancer excision, 186, 186f, 187f,
188f
lip-splitting
for mandibulotomy, 278, 278f
for segmental mandibulectomy,
267-268, 268f, 269, 269f
for lower lid blepharoplasty, 862, 864,
864f
marginal, for rhinoplasty, 808, 808f, 809f
for marginal mandibulectomy, 259, 259f
for mastoidectomy, 1166-1167, 1166f-1168f
for medial maxillectomy and lateral
rhinotomy, 69, 69f
for medialization laryngoplasty, 330, 330f
for middle fossa approach, 1027, 1027f,
1306, 1306f
for midfacial degloving procedure, 73, 74f
mucoperiosteal, for juvenile angiofi broma
surgery, 44-45, 44f
mucosal
for oropharyngeal cancer excision, 286,
286f
for phonomicrosurgery, 306, 308f
for supraglottic laryngectomy, 400, 400f
for oropharyngeal cancer excision, 286,
286f
postauricular. See Postauricular incision.
Incision(s) (Continued)
for postauricular (transtemporal)
infratemporal fossa surgery,
1008-1009, 1011f, 1012f
for rhytidectomy, 846-847, 847f-848f, 848
scalp
for anterior cranial base surgery,
985-986, 985f, 986f
for preauricular (subtemporal)
infratemporal fossa surgery, 1002,
1002f
septocolumellar, 19-20, 20f, 74f
for septoplasty, 19-20, 20f
for soft palate split, 44, 44f
for sphenoid sinus surgery, 109, 110f
submandibular, for prestyloid
parapharyngeal space tumor excision,
528-529, 528f, 529f
for thyroglossal duct cyst excision, 639,
639f
for tonsillectomy, 174, 175f
for total glossectomy, 224, 224f, 225, 225f
for total maxillectomy with orbital
exenteration, 80, 80f, 81f
for tracheostomy, 579
for transpetrosal approach to cranial base
tumor, 1033, 1033f
for tympanoplasty, 1138, 1139f
for upper lid blepharoplasty, 858-859, 859f
for uvulopalatopharyngoplasty, 154, 154f
for vertical partial laryngectomy, 414,
414f, 415f
Incisura, incision of
for foreign body removal from ear, 1096,
1096f
for osteoma removal, 1101, 1102f
Incudostapedial joint, separation of, in
stapedectomy, 1196
Incus
abnormalities of
congenital, surgical correction of,
1182-1183, 1183f-1184f
ossicular chain reconstruction for,
1152-1157, 1152f-1158f
removal of, in facial nerve tumor surgery,
1248, 1248f
Indole-3-carbinol, for recurrent respiratory
papillomatosis, 326
Infection
after anterior cranial base surgery, 995
of carotid artery, 677
after cochlear implant surgery, 1382, 1383f
after cranial base reconstruction, 1066
after facial fracture, 932
after facial nerve decompression, 1391
after juvenile angiofi broma surgery, 48-49
after laryngeal surgery, 376-377
after lateral pharyngotomy, 239-240
of orbit
fungal, 961
postoperative, 140-141, 141f
after orbital exenteration, 965
after otoplasty, 795
after percutaneous dilatational
tracheostomy, 592
after petrosal approach to cranial base
tumor, 1041
after skin cancer surgery, 734
of stoma, 585
after superfi cial lobe parotidectomy, 516

I-16
Index
Volume 1: pages 1-718
Volume 2: pages 719-1410
Infection (Continued)
after temporal bone resection, 1290-1291
third branchial arch cyst, 648
after tracheostomy, 584-585
Infectious diseases
laryngeal stenosis in, 358-359, 359f
tracheal stenosis in, 604
Inferior turbinate, steroid injection of, 4
Informed consent, for acoustic neuroma
surgery, 1301
Infraorbital nerve, in anterior antrostomy,
61, 61f
Infraorbital neurovascular bundle, 58
Infratemporal fossa
anatomic boundaries of, 997, 998t
dissection of, in glomus tumor surgery,
1330-1331, 1331f
resection of, in temporal bone resection,
1284-1286, 1285f
tumor in
biopsy of, 999-1001
clinical evaluation of, 997-999,
999f-1000f, 1001t
metastatic workup for, 1001
reconstructive/rehabilitation
considerations for, 1001
Infratemporal fossa surgery
anterior transfacial (facial translocation)
approach in, 1009, 1014-1015,
1014f-1016f
complications of, 1019-1021, 1019f-1021f
endoscopic, 1017-1018
historical background on, 997, 998t
patient selection for, 997-1001
pearls and pitfalls in, 1021
postauricular (transtemporal) approach
in, 1008-1009, 1011f-1013f
postoperative management of, 1018-1019
preauricular (subtemporal) approach in,
1002-1008, 1002f-1011f
preoperative planning for, 1001-1002,
1001t
reconstruction after, 1001, 1007-1008,
1010f-1011f
transorbital approach in, 1015, 1017,
1017f-1018f
Infratemporal skull base structures,
identifi cation of, 1005, 1007, 1007f
Injection, vocal fold. See Vocal fold
augmentation/injection.
Injection needles, for transoral vocal fold
augmentation, 296
Inlay graft, for skull defect repair
epidural, 133, 133f
subdural, 133-134, 134f
Inner ear
anatomy of, 1377
medication delivery to, 1084-1087, 1086f
Innominate artery rupture, after
tracheostomy, 585, 586f
Insect, in external auditory canal, 1093,
1094-1095
Insuffl ation test, for tracheoesophageal
puncture, 433
Intensive care unit, percutaneous dilatational
tracheostomy in, 585-593, 588f-591f
Interarytenoid synechia, in posterior glottic
stenosis, 314, 315f
Intercartilaginous incision, for medial
maxillectomy, 74f
Interdomal suture, in nasal tip surgery, 813,
813f, 814, 814f, 815f, 817
Interferon, for recurrent respiratory
papillomatosis, 326
Internal auditory canal
exposure of, 1308-1309, 1308f
in middle fossa vestibular nerve section,
1406, 1406f
facial nerve repair in, 1371
localization of, 1032, 1032f, 1308, 1308f
Intracranial bleeding, after acoustic
neuroma surgery, 1316
Intracranial complications
of otitis media, 1229-1238, 1230t-1231t,
1232f
after temporal bone resection, 1291
Intracranial extension of anterior cranial
base tumor, 979, 980f
Intracranial hypertension
after facial nerve decompression, 1391
risk of, in patient with cerebrospinal fl uid
rhinorrhea, 1057-1058, 1058f
after temporal bone resection, 1291
Intracranial pressure, minimization of, in
anterior cranial base surgery, 985
Intratympanic injections, 1084-1087, 1086f
Intubation
endotracheal
in anterior cranial base surgery, 986
in infratemporal fossa tumor surgery,
1002
in tracheal stenosis, 605
tracheal stenosis after, 603-604
laryngeal stenosis after, 358
nasogastric, laryngeal stenosis after, 358
in rigid bronchoscopy, 570, 570f
Iodine-131, after thyroid surgery, 555
Irrigation
of ear canal, for foreign body removal,
1095, 1095f
after ethmoid sinus endoscopic surgery, 97
of facial soft tissue injuries, 871
hot water, for epistaxis, 9
Isadora Duncan syndrome, 350
Ischemia
cerebral, after infratemporal fossa surgery,
1020
fl ap, after temporal bone resection, 1291
Island pedicle fl ap, for upper lip
reconstruction, 730, 731f
J
Jackson-Pratt drain, in anterior cranial base
reconstruction, 991
Jahn hydroxyapatite tube, 1129
Jejunal autograft, for esophageal
reconstruction, 481
Jejunal free fl ap, 745
disadvantages of, 745
monitor loop of, 750, 750f
for pharyngectomy defect, 748
after total laryngopharyngectomy, 470,
471f
Jennings mouth gag, in partial glossectomy,
221, 221f
Jet ventilation
high-frequency, during rigid
bronchoscopy, 572-573, 573f
in tracheal stenosis, 606
Jugular bulb
glomus tumor arising from, 1319
surgical management of, 1328-1333,
1328f-1333f
high-riding, 1185, 1185f
Jugular foramen, dissection of, in temporal
bone resection, 1283-1284, 1284f
Jugular vein, internal
anatomy of, 685
bilateral sacrifi ce of, 706
in modifi ed radical neck dissection,
697-698
in radical neck dissection, 695-696, 696,
696f, 697f
in selective neck dissection, 701, 703f
septic thrombophlebitis of, 674, 674f,
676-677
Juvenile angiofi broma, 39-50
biopsy of, 41, 42f
history and physical examination in, 39,
40f
imaging of, 39, 40f, 41, 41f
staging of, 41, 42t
surgical management of, 43-50
approaches to, overview of, 43
complications of, 48-49
endoscopic techniques for, 43-44, 43f
Le Fort I osteotomies for, 45-46, 47f-49f
pearls and pitfalls in, 49
postoperative care in, 47-48
preoperative planning in, 41-42
transpharyngeal or transpalatal
approaches to, 44-45, 44f-46f
therapeutic modalities for, 42-43
K
Karapandzic fl ap, for excision of large
tumors of the lip, 188-189, 192f
Keel, in laryngeal trauma repair, 353-354,
354f
Keratin “pearl,” in canal cholesteatoma,
1107, 1108f
Keratin plug, in keratosis obturans, 1107,
1108f
Keratoacanthoma, 724
Keratosis obturans, 1107-1111, 1108f
complications of, 1110
pearls and pitfalls in, 1110-1111
postoperative management of, 1110
preoperative evaluation of, 1109
surgical management of
patient selection for, 1109
techniques for, 1109-1110, 1109f-1110f
Kerrison punch, in sphenoid sinus surgery,
111, 111f
Kerrison rongeur
in anterior antrostomy, 61, 61f
in juvenile angiofi broma surgery, 45, 45f
in postoperative bleeding, 147, 147f
in styloid process surgery, 196, 197f
Keyhole tongue reduction, 163, 164f
Kiesselbach’s plexus, 7, 8f
Killian’s triangle, 459, 460f
Kirschner wires, on free cartilage graft for
posterior cricoid area, 370-371, 373f
Körner’s septum, removal of, in
mastoidectomy, 1169
Kuhn frontal sinus rescue procedure, 123,
124f

Index
I-17
Volume 1: pages 1-718
Volume 2: pages 719-1410
L
Labiomandibuloglossotomy, midline, 280,
281f
Labyrinthectomy. See also Translabyrinthine
approach.
for acoustic neuroma surgery, 1302-1303,
1303f
for Ménière’s disease, 1394
partial, for cranial base tumor, 1025, 1037,
1037f
surgical
complications of, 1408-1409
for vertigo, 1398-1399, 1398f-1399f
Laceration
facial, 872, 873f
trapdoor and circular/pedicled, 873
Lacrimal duct, transection of, in medial
maxillectomy and lateral rhinotomy, 69,
70f
Lacrimal surgery, for tearing correction,
967-972. See also Dacryocystorhinostomy.
Lacrimal system
anatomy of, 968f
injury to, 878-879, 922
Lagophthalmos, after blepharoplasty, 868
LAHSHAL classifi cation of clefts, 766,
766t
Lamina papyracea, 99
Laryngeal augmentation, for subglottic
stenosis in children, 375
Laryngeal cancer, 379-391
chemoradiation therapy for, 421-422
early, 382-383, 383t
endoscopic laser excision of
complications of, 390
contraindications to, 383t
general procedure for, 384f, 385
patient selection for, 379-380
pearls and pitfalls in, 390-391
positioning for, 385-386
postoperative management in, 389-390
preoperative planning for, 380-383,
381f, 382f
technique for, 383-389, 384f, 386f-389f
imaging of, 383, 383t
laryngectomy for. See also Laryngectomy.
horizontal partial, 393-409
total, 421-430
vertical partial, 411-419
laryngocele and, 342-343, 343f
neck dissection for, 422
radiation therapy for, 380, 422
staging of, 379-380, 380t
with subglottic extension, 422
supraglottic. See Supraglottic cancer.
verrucous, 381-382
Laryngeal diversion technique, for
aspiration, 595, 596
Laryngeal nerve
recurrent
identifi cation of, in thyroid lobectomy,
548f, 549-550
injury to
in cervical spine surgery, 717
during thyroid surgery, 554
intraoperative monitoring of, 554
superior
injury to, during thyroid surgery, 554
in lateral pharyngotomy, 237, 238f
Laryngeal offi ce-based procedures, 291-301
patient selection for, 291
pearls and pitfalls in, 300-301
postprocedure care/complications of,
299-300
preoperative planning for, 292, 292f
surgical techniques in, 292-299
Laryngeal papillomatosis
recurrent, 325, 326
tracheostomy in, 578, 578f
Laryngeal stenosis, 357-377. See also Tracheal
stenosis.
anatomic considerations in, 357
antibiotics in, 362
clinical assessment of, 360
complications of, 376-377
corticosteroids for, 362
dilatation for, 361
endoscopic microsurgery for, 361
etiology of, 357-360, 359f-360f
glottic, 314, 315f
after recurrent respiratory
papillomatosis surgery, 327
surgical treatment of, 363-367, 365f-370f
imaging of, 360-361, 361f
mitomycin C for, 362
pearls and pitfalls in, 377
postoperative care in, 375-376
post-traumatic, 355, 357-358
preoperative planning in, 363
stenting for, 361-362, 362f, 376
subglottic
in children, 371, 375, 375f
surgical treatment of, 367, 370-375,
371f-375f
with tracheal stenosis. See Tracheal
stenosis.
supraglottic, surgical treatment of, 363,
363f, 364f
transcervical approaches to, 361
“wait and see” approach to, 361
Laryngeal surgery, conservation. See
Laryngectomy, horizontal partial;
Laryngectomy, vertical partial.
Laryngeal trauma, 349-356
airway management in, 350-351, 353
blunt, 349-350, 350f
in children, 349
cranial nerve injury in, 351
pearls and pitfalls in, 356
penetrating, 350, 351f
postoperative management of, 354-355
preoperative assessment of, 351-352,
352f
stenosis after, 355, 357-358
strangulation as, 350, 352, 352f
surgical management of, 353f-355f,
354-355
vascular injury in, 351
Laryngectomy
horizontal partial, 393-409
anatomic considerations in, 394-395,
394f, 395f
contraindications to, 398
patient selection for, 395-396
pearls and pitfalls in, 409
preoperative evaluation in, 396-398,
396f, 397f
techniques of, 398-409
types of, 393, 394t
Laryngectomy (Continued)
supracricoid partial, with
cricohyoidoepiglottopexy, 403-408
overview of, 393-394
pearls and pitfalls in, 406, 408
postoperative care in, 406
preoperative evaluation in, 403
technique of, 403-406, 404f-407f, 404t
supraglottic
extended, 401-402, 409
overview of, 393
pearls and pitfalls in, 402-403
postoperative management of, 402
technique of, 398-402, 399f-402f, 399t
transcervical, 363, 363f, 364f
total, 421-430
neck dissection in, 422
and partial pharyngectomy, 470
patient selection for, 421-422
pearls and pitfalls in, 430
preoperative planning for, 422-423
technique of, 423-430, 423t, 424f-429f
tracheostomal stenosis after, 623-627,
625f-627f
voice restoration after, 431-437,
432f-437f
vertical partial, 411-419
epiglottopexy with, 415, 417, 418f-419f
frontolateral, 411, 412f
patient selection for, 411-412, 412f,
413t
pearls and pitfalls in, 419
postoperative care in, 413t, 417
preoperative planning for, 412, 412f
technique of, 412-417, 413t, 414f-417f
Laryngocele, 341-346
combined form of, 341, 342f
complications of, 346
excision of
patient selection for, 343-344, 343f
pearls and pitfalls in, 346
postoperative management of, 346
technique of, 344-346, 344f, 345f
infected, 342, 343
squamous cell carcinoma and, 342-343,
343f
symptoms of, 342, 343
Laryngocutaneous fi stula, after
laryngofi ssure, 338
Laryngoesophagectomy, total, 468, 468f,
470, 470f
Laryngofi ssure, 335-339
for anterior glottic stenosis, 365, 366f
complications of, 338-339
for laryngeal trauma surgery, 353, 353f
patient selection for, 335
for posterior glottic stenosis, 367
preoperative evaluation for, 335-336
technique of, 336-338, 336f-338f
Laryngopharyngectomy
partial, 408-409, 409f, 468, 469-470
total, 468, 470, 470f, 471f
Laryngopharyngoesophagectomy
with colonic transposition, 481
with free fl aps, 481
with gastric transposition and
pharyngogastric anastomosis, 480,
480f
postoperative management and
complications of, 482

I-18
Index
Volume 1: pages 1-718
Volume 2: pages 719-1410
Laryngopharyngoesophagectomy (Continued)
technique of, 478, 479f-480f
tracheostoma creation after, 481
Laryngoplasty
epiglottopexy, after anterior glottic
stenosis surgery, 366, 367f, 368f
medialization, 329-333
with arytenoid adduction, 331-332, 332f
complications of, 332-333
equipment for, 329-330
patient selection for, 329
pearls and pitfalls in, 333
postoperative care in, 332
preoperative planning for, 330
technique, 330-331, 330f, 331f
Laryngopyocele, 342, 343
Laryngoscope, in rigid bronchoscopy, 570,
571f-572f
Laryngoscopy
botulinum toxin injection guided by, 295
fl exible fi beroptic, in laryngotracheal
stenosis, 604, 604f
fl exible nasopharyngeal, of vocal fold
lesions, 304, 305
in laryngeal stenosis, 360
in laryngocele, 343
microsuspension
and laser excision, for laryngeal
carcinoma, 383-389, 384f, 386f-389f
for phonomicrosurgery, 305-306, 305f
for recurrent respiratory papillomatosis,
324
for vocal fold augmentation/injection,
319-320, 320f
in tongue base and hypopharyngeal
tumor, 236
Laryngotracheal separation, 595-601
complications of, 600
patient selection for, 596-597, 597f, 597t
pearls and pitfalls in, 600-601
postoperative care in, 599
preoperative planning for, 597-598
procedure for, 598-599, 598f-600f
tracheoesophageal puncture after, 596
Laryngotracheal stenosis. See Tracheal
stenosis.
Larynx. See also specifi c anatomic area, e.g.,
Supraglottis.
anatomy and physiology of, 349, 350f
anesthesia of, 295-296, 296f
biopsy of, offi ce-based, 300, 300f
landmarks for, in cervical spine surgery,
709, 710f
reconstruction of, epiglottopexy for, 415,
417, 418f-419f
saccular cyst of, 341-346. See also
Laryngocele.
thyrohyoid approach to, 298f, 299
Laser incision, in transverse cordotomy, 312,
313f
Laser surgery
for anterior glottic stenosis, 364-365, 365f
for laryngeal carcinoma, 383-389, 384f,
386f-389f
for laryngeal stenosis, 361
for laryngocele, 344, 344f
for premalignant glottic lesions, 381, 382f
for recurrent respiratory papillomatosis,
324
safety precautions for, 385
Laser surgery (Continued)
for skin cancer, 720
for tonsillectomy, 173
Lateral arm fasciocutaneous fl ap, 741-742,
742f
Lateral chain fi xation, ossicular chain
reconstruction for, 1159-1160, 1160f
Lateral cricoarytenoid–thyroarytenoid
muscle complex. See Thyroarytenoid-
lateral cricoarytenoid muscle complex.
Lateral crural overlay, in nasal tip surgery,
815, 816, 816f
Lateral nasal incision, for orbital rim
fracture repair, 918
Lateral spread response, in hemifacial
spasm, 1386, 1387f
Latissimus dorsi free fl ap
for cranial base reconstruction, 1064,
1065f
for skull base defects, 749, 749f
Latissimus dorsi muscle fl ap, 756-757, 756f
Latissimus dorsi myocutaneous fl ap, for
reconstruction of extended
maxillectomy with orbital exenteration,
87-88, 87f-88f
Le Fort fracture
preoperative evaluation of, 906, 906f
treatment of, 912-914, 913f-915f
Le Fort I osteotomies
in juvenile angiofi broma surgery, 45-46,
47f-49f
in maxillomandibular advancement
surgery, 157, 157f
Leeches, for venous decompression after
temporal bone resection, 1287-1288,
1288f
Lidocaine
for laryngeal anesthesia, 295-296, 296f
for transnasal esophagoscopy, 446
for tympanic membrane anesthesia,
1076-1077
Lidocaine with epinephrine
for botulinum toxin injection, 294
for external ear and canal anesthesia,
1077
for facial soft tissue injuries, 876
for frontal sinus endoscopic surgery,
122
for lip cancer excision, 186
for lower lid blepharoplasty, 862, 862f
for medialization laryngoplasty, 330
for optic nerve decompression, 957
for postoperative tonsillar bleeding, 179
for rhytidectomy, 846
Lindeman’s procedure, for aspiration, 595,
596
Lingual nerve
injury to, in phonomicrosurgery, 309
in transcervical submandibular gland
excision, 507, 508f
Liothyronine sodium, for hypothyroidism,
555
Lip
cleft. See Cleft lip entries.
injury to, 875f, 883-884
lower
reconstruction of, 730-731
static reanimation procedures on, 841,
841f, 842f
wedge resection of, 841, 842f
Lip (Continued)
lymphatic drainage of, 184
minor salivary gland of, biopsy of,
491-493, 492f-493f
upper, reconstruction of, 729-730, 731f
Lip adhesion technique, for facial cleft
repair, 769, 770f
Lip cancer, 183-193, 728
biopsy of, 184
excision of
in large cancers, 186-189, 189f-192f
objectives in, 185
patient selection for, 183-184, 184f
pearls and pitfalls in, 193
postoperative management of, 189,
193
preoperative planning for, 184-185
in small cancers, 185-186, 186f-188f
imaging of, 185
radiation therapy for, 185
risk factors for, 183
staging of, 184
types of, 183
“Lip switch” fl ap, for large lip tumor
excision, 187-188, 191f, 192f
Lipoinjection, for vocal fold augmentation,
319, 320-321, 321f
Lipoma
in parapharyngeal and retropharyngeal
space, 659f
in prestyloid parapharyngeal space, 525,
526f
Liposuction, in rhytidectomy, 848
Lip-splitting incision
for mandibulotomy, 278, 278f
for segmental mandibulectomy, 267-268,
268f, 269, 269f
Little’s area, 7, 8f
Lobectomy, thyroid, 547-550, 548f-549f
Local fl ap, for palatal defect repair, 213
Ludwig’s angina, 671
Lumbar drainage
in anterior cranial base surgery, 985
for cerebrospinal fl uid leak, 135, 1057,
1058f, 1290
Lung
anatomy of, 565, 566f
cancer of, metastasis of, 184
Lymph nodes
cervical
drainage by, predictability of, 686
levels of, 681, 681f, 686
metastasis to, 208, 211
of cancer of fl oor of the mouth, 241,
243, 244f
occult, 679-680
in neck cancer staging, 679, 680f
sentinel, biopsy of, 686-687
elective dissection of. See also Neck
dissection.
for melanoma of head and neck,
725
enlarged, fi ne-needle aspiration biopsy of,
630
retropharyngeal, metastasis to, 207, 208,
208f, 283-284, 285f
Lymphangiomatous macroglossia, 162, 163f,
165-166, 166f
Lymphatic pedicle, in radical neck
dissection, 696, 696f

Index
I-19
Volume 1: pages 1-718
Volume 2: pages 719-1410
Lymphoma
of hard palate, 205, 206f
of soft palate, 199, 200f
of thyroid gland, 542-543
of tonsil, 283, 284f
Lynch’s frontoethmoidectomy, 117-118,
118f
M
Macroglossia
conditions causing, 161
reduction procedures for, 161-167
complications of, 166-167
patient selection for, 161-162, 162f
pearls and pitfalls in, 167
postoperative management of, 166
preoperative planning for, 162-163,
162f-164f
types of, 163-166, 164f-166f
Magnetic resonance angiography (MRA)
in glomus tumor, 1322-1323, 1323f
in infratemporal fossa tumor, 999
in temporal bone cholesterol granuloma
and epidermoid tumor, 1343
Magnetic resonance imaging (MRI)
in acoustic neuroma, 1299f, 1300, 1300f,
1314, 1315t
in anterior cranial base tumor, 980f,
981-982, 982f, 983f
in buccal space tumor, 535, 535f
in cerebrospinal fl uid otorrhea, 1361,
1362f
in cerebrospinal fl uid rhinorrhea, 132,
133, 1054, 1055f
in cervical esophageal cancer, 477
of cervical spine, 710f, 712
in cochlear implant candidate, 1379
in facial nerve tumor, 1243, 1244f, 1246
in glomus tumor, 1322, 1322f
in hemifacial spasm, 1386
in hypopharyngeal tumor, 235-236
in infratemporal fossa tumor, 999, 999f
in juvenile angiofi broma, 39, 40f
in laryngeal stenosis, 360-361
in laryngocele, 343
in laryngotracheal stenosis, 605
in lip cancer, 185
in maxillary sinus tumor, 78, 79f
in maxillary sinusitis, 59-60
in optic nerve decompression, 956f, 957
in otosclerosis, 1192
in plunging ranula, 500, 501f
in prestyloid parapharyngeal space tumor,
525, 526f
in temporal bone carcinoma, 1277-1278,
1278f
in temporal bone cholesterol granuloma
and epidermoid tumor, 1341-1342,
1341f, 1342f, 1342t, 1343, 1354,
1354f
in thyroglossal duct cyst, 638
in tongue base tumor, 230, 235-236
in tongue cancer, 220, 220f, 223, 223f
of tumor invasion into bone, 265, 265f
of tumor involving nasal cavity and
paranasal sinuses, 68, 69f
Malar eminence osteotomy, in preauricular
(subtemporal) infratemporal fossa
surgery, 1005, 1006f
Malleus, abnormalities of
congenital, surgical correction of,
1183-1185, 1184f-1185f
ossicular chain reconstruction for,
1159-1160, 1160f
Malocclusion
after facial fracture repair, 932
after infratemporal fossa surgery, 1019,
1019f
Malunion, after laryngofi ssure, 339
Mandible
fl oor of mouth cancer involving, 243,
244f, 249-252, 250f-251f
fracture of. See Mandibular fracture.
reconstruction of
distraction osteogenesis for, 267
free fl ap for, 224, 250, 251f, 252, 273,
274f, 740f, 744f, 746-747
methods of, 266-267, 266t
plates for, 741f, 747
Mandibular advancement surgery. See also
Maxillomandibular advancement
surgery.
for obstructive sleep apnea, 156-157, 156f,
157f
Mandibular alveolus, tumor arising on
marginal mandibulectomy for, 263, 264f
osteotomies for, 249, 251f
radiography in, 264-265, 265f
visor fl ap for, 249, 250f
Mandibular condyle osteotomy, in
preauricular (subtemporal)
infratemporal fossa surgery, 1004, 1005f
Mandibular fracture, 885-902
classifi cation of, 885, 886f
involving angle, 894-896, 895f-896f
involving body, 892-894, 893f-894f
involving condyle, 897-898, 897f, 899f
involving coronoid, 896
involving ramus, 897
involving symphysis and parasymphysis,
891-892, 891f
involving teeth, 889-890
after mandibulectomy, 260
multiple, 898, 900f-902f
open versus closed, 885
pathologic, 265f
treatment of, 888-898
arch bar and maxillomandibular
fi xation in, 888-889, 889f-891f
in children, 898, 899f
open versus closed, 888
patient selection for, 887
pearls and pitfalls in, 902
postoperative management after, 898
preoperative planning for, 887-888
Mandibular osteoradionecrosis, segmental
mandibulectomy for, 263
Mandibulectomy
marginal, 255-260
complications of, 260
defi nition of, 264t
indications for, 255-256, 256f, 257f
for mandibular alveolar tumor, 263,
264f
in mouth fl oor cancer surgery, 245,
246-247, 248f
patient selection for, 257
pearls and pitfalls in, 260
postoperative management of, 260
Mandibulectomy (Continued)
preoperative planning for, 257-258
technique of, 258-260, 259f-260f
segmental, 263-275
defi nition of, 264t
indications for, 263
neck dissection before, 268
patient selection for, 263-266, 264f-265f
pearls and pitfalls in, 275
postoperative management of, 273-274
preoperative planning for, 267-268, 268f
prosthetic rehabilitation after, 268
reconstruction after, 272-273, 273f, 274f
technique of, 268-273, 269f-273f
in tongue base tumor, 229
for total glossectomy, 224, 224f, 226
Mandibulotomy, 277-280
defi nition of, 264t
in excision of cancer of fl oor of mouth,
249, 249f-250f
with midline tongue-splitting approach,
280, 281f
patient selection for, 277
pearls and pitfalls in, 282
postoperative management of, 279-280
preoperative evaluation for, 277-278
prestyloid parapharyngeal space tumor
excision with, 529-530
technique of, 278-279, 278f, 279f
in tongue base tumor excision, 229
in total glossectomy, 226
total parotidectomy with, 519, 519f
Mannitol
for intracranial hypertension, 1291
during temporal bone resection, 1279
Manometry, of upper esophageal sphincter,
462
Marginal incision, for rhinoplasty, 808, 808f,
809f
Marginal mandibular nerve
injury to, in neck dissection, 704
in neck dissection, 692, 692f
in transcervical submandibular gland
excision, 506-507, 507f, 508
Margins, positive, survival and, 256, 258f
Masseteric fascia, separation of, in
preauricular (subtemporal)
infratemporal fossa surgery, 1003, 1003f
Mastication, facial sweating and fl ushing
during. See Frey’s syndrome.
Mastoid, congenital epidermoid tumor of,
1340-1341
Mastoid dressing, in microtia reconstruction,
798
Mastoidectomy, 1163-1176. See also
Transmastoid approach.
anesthesia for, 1166
Bondy-modifi ed radical, 1163, 1173, 1173f
canal wall down, 1163, 1171-1173,
1172f-1173f
complications of, 1175-1176
incisions for, 1166-1167, 1166f-1168f
intact canal wall, 1163, 1167-1170,
1168f-1170f, 1175-1176
meatoplasty with, 1173-1174, 1174f-1175f
patient selection for, 1164, 1164f, 1165f
pearls and pitfalls in, 1176
posterior tympanotomy with, 1170-1171,
1170f, 1171f
postoperative management of, 1174-1175

I-20
Index
Volume 1: pages 1-718
Volume 2: pages 719-1410
Mastoidectomy (Continued)
preoperative evaluation for, 1164-1165
radical, 1173, 1174f
surgical techniques for, 1165-1174
in transpetrosal approach to cranial base
tumor, 1034, 1035f
tympanoplasty with, 1134, 1155-1157,
1157f-1158f, 1175
vascular strip in, establishment of, 1166,
1166f
Maxillary artery, internal, 58
anatomy of, 8, 9f
in total maxillectomy, 80
Maxillary cleft bone grafting, 787-788, 787f
Maxillary fracture
orbital fracture and, 935-939
preoperative evaluation of, 906, 906f
treatment of, 912-915, 913f-915f
Maxillary molar tooth, extraction of,
oral-antral fi stula after, 63, 64f
Maxillary sinus
accessory ostium of, 52, 52f
anatomy of, 57, 58f
hypoplasia of, 57, 58f
natural ostium of, 51, 52f
obstruction of, oral-antral fi stula with, 63,
64f
tumor of
imaging of, 78, 79f
staging of, 77, 78f
standard therapy for, 77. See also
Maxillectomy.
Maxillary sinus surgery
endoscopic, 51-56
complications of, 54-55, 55f
patient selection for, 51-52, 52f
postoperative care in, 54
preoperative planning for, 52-53, 53f
technique of, 53-54, 53f-54f
open. See Antrostomy, anterior (Caldwell-
Luc procedure).
Maxillary sinus tap, in acute bacterial
sinusitis, 2
Maxillary sinusitis
imaging in, 59-60, 59f
odontogenic, oral-antral fi stula in, 63
surgical options for, 51-52, 52f
Maxillectomy
defects after, free fl ap for, 743f, 749
inferior
for hard palate cancer, 210-211, 211f
loss of oral-nasal separation after,
rehabilitation of, 211-214, 213f-214f
medial, 67-75
and lateral rhinotomy, 67-73
complications of, 72-73, 73f
patient selection for, 68, 69f
postoperative management of, 72
preoperative planning for, 68, 68f,
69f
technique of, 69-72, 69f-72f
and midfacial degloving procedure, 73,
74f
pearls and pitfalls in, 75
partial lateral, for hard palate cancer,
209-210, 209f-210f
total, 77-88
with orbital exenteration, 81-84
reconstruction of, 86-88, 86f-88f
patient selection for, 77-78, 78f
Maxillectomy (Continued)
postoperative management of, 85-88
preoperative evaluation for, 78-79, 79f
technique of, 79-81, 80f-85f
Maxillofacial prosthesis
after oropharyngeal cancer excision, 285,
288, 289f
for soft palate reconstruction, 200,
201-202
after total maxillectomy, 78-79, 81, 84f, 85,
85f
Maxillomandibular advancement surgery,
for obstructive sleep apnea, 157-158,
157f, 158f
Maxillomandibular fi xation, arch bar and,
for midfacial and upper facial fracture,
912
Mayfi eld horseshoe head holder, 986, 1247,
1247f
Meatoplasty, with mastoidectomy, 1173-1174,
1174f-1175f
Medial crural overlay, in nasal tip surgery,
817
Medullary carcinoma, of thyroid gland, 542
Melanoma
of head and neck
elective lymph node dissection for, 725
excision of, 724-725, 725f
preoperative evaluation of, 723
malignant
of hard palate, 205, 206f
orbital exenteration for, 961, 962f
Menick’s technique, for nasal lining
reconstruction, 827-828, 829f-830f
Ménière’s disease
otosclerosis associated with, 1191
versus perilymphatic fi stula, 1220
vertigo in, intratympanic gentamicin for,
1084, 1085, 1086
Meningeal artery, middle, in middle fossa
approach to petrous carotid artery,
1030, 1031f
Meningitis
after acoustic neuroma surgery, 1316
in cerebrospinal fl uid leak, 1360
after cochlear implant surgery, 1383
in otitis media, 1229, 1232, 1232f
prophylaxis for, in cochlear implant
candidate, 1379, 1379t
Meningoencephalocele
cerebrospinal fl uid leak in, 1359-1360,
1360f
magnetic resonance imaging of, 1054,
1055f
Mental nerve, in mandibular body fracture
surgery, 892, 893
Merkel cell carcinoma, of head and neck,
725-726
Merocel balls, after tympanoplasty, 1143,
1143f
Merocel sponge, after aural atresia repair,
1120, 1120f
Merocel stent, after exostoses removal, 1103,
1104f
Metallic stent, for tracheal stenosis, 606
Methylprednisolone
for facial fracture, 931
for optic neuropathy and visual
compromise, 931
Microbipolar forceps, 1326, 1326f
Microcystic adnexal neoplasm, 725
Microdébrider
in adenoidectomy, 36
in anterior cranial base surgery, 992
in anterior ethmoidectomy, 94-95
orbital complications and, 139, 140
for recurrent respiratory papillomatosis,
324, 325
in turbinate reduction, 23, 23f, 24f
Microear drill, 1326, 1326f
Microfl ap technique, in phonomicrosurgery,
306, 308f, 309f
Microlaryngeal instruments, for
phonomicrosurgery, 306
Microlaryngoscopy. See Laryngoscopy,
microsuspension.
Microsurgery, endoscopic. See also
Phonomicrosurgery.
for anterior glottic stenosis, 364-365, 365f
for laryngeal stenosis, 361
laser-based. See Laser surgery.
for subglottic stenosis, 367, 370, 371f
for tracheal stenosis, 607, 607f
Microtia, 797-805
in aural atresia, 1113, 1114f
bilateral, staging of surgery for, 802,
804-805
preoperative evaluation of, 797-798
reconstruction of, 798-805
patient selection for, 797
pearls and pitfalls in, 805
postoperative management in, 805
stage 1, 798-799, 798f-800f
stage 2, 799-800, 800f
stage 3, 800-801, 801f-802f
stage 4, 801-802, 802f-804f
revision surgery for, 805
Microtrapdoor fl ap, in posterior glottic
stenosis, 314, 367, 369f-370f
Microvascular decompression of facial nerve,
1385-1392. See also Facial nerve
decompression.
Microvascular free tissue transfer
reconstruction, 739-751. See also Free
fl ap.
Middle ear
congenital cholesteatoma of, 1340, 1340f
disease of, management of, in
tympanoplasty, 1140-1144,
1142f-1144f
endoscopy of, 1088-1090, 1090f
glomus tumor arising from, 1319,
1325-1326, 1326f
malformations of, 1177-1187
preoperative evaluation of, 1178-1179,
1178f
surgical correction of
anesthesia for, 1180
complications of, 1187
facial nerve aberration in, 1180-1181,
1180f, 1181f
for incus defects, 1182-1183,
1183f-1184f
for malleus defects, 1183-1185,
1184f-1185f
patient selection for, 1177-1178,
1178f
pearls and pitfalls in, 1187
postoperative management after,
1186-1187

Index
I-21
Volume 1: pages 1-718
Volume 2: pages 719-1410
Middle ear (Continued)
for round window abnormalities,
1186
for stapes defects, 1181-1182,
1181f-1182f
tympanomeatal fl ap in, 1180, 1180f
for vascular abnormalities, 1185-1186,
1185f-1186f
in patients with cleft palate, 780-781
structures in, exposure of, 1170, 1170f,
1171f
ventilation of. See Myringotomy;
Tympanocentesis.
Middle ear squeeze, tympanostomy tube
placement for, 1126
Middle fossa
fl oor of, anatomy of, 1265f, 1306-1307,
1308f
surface anatomy of, 1030, 1030f
Middle fossa approach
to acoustic neuroma, 1298, 1306-1309,
1307f-1309f
in cerebrospinal fl uid otorrhea surgery,
1361-1362, 1364, 1364f
to facial nerve decompression, 1263-1266,
1264f-1267f, 1269
to facial nerve tumor, 1250-1251,
1250f-1251f
incision for, 1027, 1027f, 1306, 1306f
to petrous carotid artery, 1024-1025,
1027-1032, 1027f-1031f
to temporal bone fracture, 1372-1373,
1373f
in vestibular nerve section, 1405-1407,
1405f-1407f, 1409
Middle fossa–transmastoid approach, to
facial nerve tumor, 1251-1252, 1251f
Middle meatal antrostomy, in postoperative
bleeding, 146
Middle meatal aspiration, endoscopic, in
acute bacterial sinusitis, 2
Midface, free fl ap for, 743f, 749
Midfacial and upper facial fracture, 905-932.
See also specifi c anatomic location, e.g.,
Nasal fracture.
airway management in, 912
hemorrhage in, 905
Le Fort classifi cation of, 906, 906f
pearls and pitfalls in, 932
preoperative evaluation of, 906-912
treatment of
by anatomic location, 912-930
goals of, 905-906
postoperative management after,
931-932
sequencing of, 912
Midfacial degloving procedure
in anterior cranial base surgery, 984, 984f
medial maxillectomy and, 73, 74f
Midline labiomandibuloglossotomy, 280,
281f
Midpalate split, for juvenile angiofi broma
surgery, 44, 44f
Millard rotation-advancement technique, for
unilateral cleft lip repair, 770-773,
771f-773f
Miniplates, in laryngeal trauma repair, 354,
354f, 355f
Minor’s iodine-starch test, for hyperhidrosis,
497
Mirrors, in adenoidectomy, 35, 35f
Mitomycin C
for laryngeal stenosis, 362
for tracheal stenosis, 607
Mitral regurgitation, in neck cancer staging,
688
Mohs surgery, for skin cancer, 721, 727
Montgomery’s aperture, 337, 337f
Montgomery’s umbrella, in anterior glottic
web lysis, 365, 366f
Mouth cancer, fl oor of, 241-252, 255, 257f
cervical metastasis of, 241, 243, 244f
imaging of, 243-244, 244f
with mandibular infi ltration, 243, 244f,
249-252, 250f-251f
neck dissection in, 242, 247
palpation of, 243, 243f
radiation therapy for, 242
transoral excision of
for extensive lesions, 248-249, 249f-250f
for extensive lesions with mandibular
involvement, 249-252, 250f-251f
for limited lesions, 245-247, 246f-248f
patient selection for, 242-243
pearls and pitfalls in, 252
preoperative evaluation of, 243-245,
243f-245f
treatment strategies for, 241-242
Mouth reconstruction, fl oor of, 241, 247
Mouth gag
in oropharyngeal cancer excision, 286
for tonsillectomy, 173, 174, 174f
MRI. See Magnetic resonance imaging
(MRI).
Mucocele
ethmoid, 92
after medial maxillectomy and lateral
rhinotomy, 73, 73f
Mucociliary fl ow, in maxillary sinus, 58, 58f
Mucoperichondrial fl ap
septal, for nasal lining, 826f, 827
in septoplasty, 21, 22f
Mucoperichondrial/mucoperiosteal fl ap,
for skull defect repair, 134, 134f-135f,
1056
Mucoperiosteal fl ap
in juvenile angiofi broma surgery, 45, 45f
for palatal defect repair, 213
Mucoperiosteal incision, for juvenile
angiofi broma surgery, 44-45, 44f
Mucormycosis, rhino-orbital-cerebral, 961
Mucosal incision
for oropharyngeal cancer excision, 286,
286f
for phonomicrosurgery, 306, 308f
for supraglottic laryngectomy, 400, 400f
Muir-Torres syndrome, skin cancer in,
721-722
Multiple-fl ap technique, for reconstruction
at cleft site, 787, 787f
Muscle fl ap
deltopectoral, 761, 761f
latissimus dorsi, 756-757, 756f
sternocleidomastoid, 757
temporalis, 759-761, 760f
trapezius, 757-758, 758f
Musculoperiosteal fl ap
in cochlear implant surgery, 1380, 1380f
in transpetrosal approach to cranial base
tumor, 1033-1034, 1034f
Mustardé sutures, for otoplasty, 793-794,
794f
Mylohyoid muscle, in transcervical
submandibular gland excision, 507,
507f
Mylohyoid muscle sling, 671, 672f
Myocutaneous fl ap
latissimus dorsi. See Latissimus dorsi
myocutaneous fl ap.
pectoralis major. See Pectoralis major
myocutaneous fl ap.
rectus abdominis, 742, 743f, 964f,
965
Myofascial graft, pectoralis, after lateral
pharyngotomy, 239
Myokymia, facial, 1386, 1386t
Myotomy
cricopharyngeal
indications for, 459
pearls and pitfalls in, 465
postoperative management of, 465
preoperative planning for, 462
with supraglottic laryngectomy, 400
technique of, 460, 462-463, 462f-463f
in tracheoesophageal puncture, 434
Myringoplasty
anesthesia for, 1135
patient selection for, 1133-1135
pearls and pitfalls in, 1145
postoperative management of, 1144
preoperative planning for, 1135
technique of, 1135-1137, 1136f-1137f
Myringotomy, 1123-1131
laser, 1124
patient selection for, 1124-1126, 1126f
with tube placement
choice of tubes in, 1127, 1127f
complications of, 1130-1131, 1130f
offi ce-based, 1087-1088, 1089f
patient selection for, 1124-1126, 1126f
pearls and pitfalls in, 1131
postoperative management of,
1129-1130
preoperative planning for, 1126-1127,
1127f
surgical technique for, 1127-1129,
1128f-1129f
vaccination and, 1124
without tube, indications for, 1125
N
Nasal ala, reconstruction of, 829-830, 833f
Nasal artery, posterior
anatomy of, 9, 9f, 10f, 143, 144f
ligation of, 146-147, 146f-148f
Nasal cancer, 728
Nasal cavity
blood supply to, 143-144, 144f-145f
tumor of, medial maxillectomy for, 68,
68f
Nasal Cease, for anterior epistaxis, 3
Nasal defects, analysis of
by adjacent and underlying facial
structures, 821-822, 823f-825f
by nasal layers, 822, 825f
by nasal subunits, 822, 825f
Nasal dorsum, widening of, in anterior
cranial base tumor, 979, 981f
Nasal endoscopy, diagnostic, 1-3

I-22
Index
Volume 1: pages 1-718
Volume 2: pages 719-1410
Nasal fracture
patterns of, 910f
preoperative evaluation of, 909-910, 910f
surgical repair of, 920, 922, 923f
Nasal injuries, 882, 882f
Nasal lining, 822, 827-828
bipedicled fl ap interposition for, 826f,
827, 827f-828f
free fl ap for, 828, 831f, 832f
Menick’s technique for, 827-828, 829f-830f
septal mucoperichondrial fl ap for, 826f,
827
turnover/turn-in fl ap for, 822, 826f, 827
Nasal midline support, bone graft for, 829,
832f
Nasal obstruction
etiology of, 17, 18, 18t
static facial reanimation for, 841
surgical correction of, 17-25. See also
Septoplasty; Turbinate reduction.
complications of, 24-25
patient selection for, 17-18
pearls and pitfalls in, 25
postoperative management in, 24
preoperative planning for, 18-19, 19t
techniques for, 19-24, 20f-24f
Nasal packing
in endonasal skull base reconstruction,
993-994
for epistaxis, 9
in septoplasty, 23
Nasal polypectomy, 100-101, 100f
Nasal polyps. See also Antrochoanal polyp.
alligator forceps removal of, 4
endoscopic sinus surgery for, 97
with eosinophilic mucin, 3
in-offi ce microdébridement of, 4
steroid injection for, 3-4
Nasal profi le reduction/alignment, 810-812,
811f-812f
Nasal prosthesis, 821, 822f
Nasal reconstruction, 821-837
in bilateral cleft lip repair, 776
nasal lining options in, 822, 826f-832f,
827-828. See also Nasal lining.
nasal skin coverage in, 830, 832, 833f-836f,
834-836. See also Nasal skin coverage.
in nasal-orbital-ethmoid (NOE) complex
fracture, 923, 925f-926f
patient selection for, 821
pearls and pitfalls in, 836-837
postoperative management of, 836
preoperative planning for, 821-822,
823f-825f
skeletal support in, 828-830, 832f, 833f
after tumor resection, 731-732, 732f-734f
in unilateral cleft lip repair, 771, 772f, 773
Nasal septal button, placement of, 5
Nasal septum
blood supply to, 7-9, 8f-10f
caudal shortening of, in nasal tip surgery,
814
deviation of, 17
etiology of, 18
severe caudal, repair of, 21-22, 22f
surgical correction of. See Septoplasty.
evaluation of, after maxillary fracture
repair, 915
fracture of, 920
hematoma of, after septoplasty, 24
Nasal septum (Continued)
perforation of
atrophic rhinitis with, 3
biopsy of, 3
after septoplasty, 24
Nasal skin coverage, 830, 832, 834-836
composite chondrocutaneous graft for,
832, 833f, 834f
forehead fl ap for, 835-836
full-thickness skin graft for, 830, 832
nasolabial fl ap for, 834-835, 837f
Zitelli’s bilobed fl ap for, 832, 834, 835f
Nasal skin types, 822, 825f
Nasal subunits, 822, 825f
Nasal tip surgery, 812-817
caudal septum shortening in, 814
cephalic trim in, 813, 813f
complications of, 818
dorsal reduction in, 814, 818
goals of, 812
lateral crural overlay in, 815, 816, 816f
medial crural overlay in, 817
tip defi nition in, 812-814, 813f-815f
tip graft in, 817
tip projection in, 815-817, 816f-817f
tip rotation in, 814-815, 815f-816f
tip suturing in, 813, 813f, 814, 814f, 815f,
817
vertical dome division in, 813-814,
814f-815f, 815, 817, 817f
Nasal valve, collapse of, with inspiration,
2-3
Nasality, in patients with cleft palate, 780,
780t
Nasal-orbital-ethmoid (NOE) complex
fracture, 936
preoperative evaluation of, 910, 910f
surgical repair of, 922-923, 924f-926f
Nasoalveolar molding, for facial cleft,
768-769, 769f
Nasoantral window
for anterior antrostomy, 61, 61f
for juvenile angiofi broma surgery, 43-44,
43f
Nasogastric intubation, laryngeal stenosis
after, 358
Nasolabial fl ap
for nasal lining, 827, 827f-828f
for nasal reconstruction, 731, 733f
for nasal skin coverage, 834-835, 837f
Nasolacrimal duct obstruction, 967
Nasomaxillary complex (Le Fort II) fracture
preoperative evaluation of, 906, 906f
treatment of, 913
Nasopharyngeal airway, as stent, in choanal
atresia repair, 30, 31f
Nasopharyngeal anesthesia, 295
Nasopharyngoscopy, in velopharyngeal
incompetence, 782
Nasopharynx
juvenile angiofi broma of. See Juvenile
angiofi broma.
stenosis of, after
uvulopalatopharyngoplasty, 155,
155f
Nasoseptal fl ap
for endonasal skull base reconstruction,
994
harvesting of, 992
for skull defect repair, 134, 134f-135f
Neck. See also Cervical entries; Head and
neck.
anatomy of, 681-686, 681f-686f
skin cancer on, 728, 733
trauma to
deep neck abscess after, 674
penetrating, 452, 452f
Neck abscess
deep, 671-677
bacteriology of, 674
description of, 671-674, 672f-674f
etiology of, 674, 674f
incision and drainage of, 675-677, 676f
pearls and pitfalls in, 677
postoperative management of, 677
preoperative evaluation of, 675, 675f
in parapharyngeal space, 671-672,
672f-673f, 675f, 676, 676f
in prevertebral space, 673-674, 674f
in retropharyngeal space, 672-673, 673f,
676
in submental-submandibular space, 671,
672f
in third branchial arch cyst infection, 648
Neck dissection, 679-707
anatomic structures in, 681-686, 681f-686f
in cervical esophageal cancer surgery, 478
classifi cation of, 687, 688f-689f
complications of, 703-706
intraoperative, 704
postoperative, 704-706
preoperative, 704
extended, 687
in fl oor of mouth cancer, 242, 247
functional, 681
in glomus tumor surgery, 1328, 1328f,
1330
in hard palate cancer, 211
“hockey stick” incision for, 691, 692f
in oropharyngeal cancer, 283, 287
in partial laryngopharyngectomy, 408
patient selection for, 688-689, 690f
pearls and pitfalls in, 706-707
posterolateral, 702-703
postoperative management of, 703
preoperative planning for, 689-690
preoperative radiologic staging in, 688,
689f
versus radiation therapy, 690
radical, 687, 688f
description of, 680-681
modifi ed, 687, 688f-689f, 697-698,
697f-698f
steps in, 691t
technique of, 690-697, 692f-697f
in segmental mandibulectomy, 268
selective
advantages of, 689
steps in, 691t
techniques of, 698-702, 699f-703f, 707f
in supraglottic carcinoma, 397
techniques of, 690-703, 691t
with temporal bone resection, 1276
in thyroid surgery, 552-553, 553f
in total laryngectomy, 422
Neck mass. See also Branchial cleft remnants.
cystic, differential diagnosis of, 633
midline. See also Thyroglossal duct cyst.
differential diagnosis of, 635
evaluation of, 637-638, 638f

Index
I-23
Volume 1: pages 1-718
Volume 2: pages 719-1410
Neck skin fl ap, in rhytidectomy, 848, 849f
Necrosis
fl ap
after rhytidectomy, 855
scalp, 1019, 1020f, 1065-1066
after skin cancer surgery, 734-735
after superfi cial lobe parotidectomy,
516
graft, after skin cancer surgery, 734-735
Necrotizing cervical fasciitis, 676
Needle aspiration biopsy. See Fine-needle
aspiration biopsy (FNAB).
Needles
for facial repair and reconstruction, 876
for transoral vocal fold augmentation, 296
Neonatal hemochromatosis, lip biopsy in,
491
Nerve block, four-quadrant canal, 1077,
1078f
Nerve cable graft, for facial nerve repair,
521, 521f
Nerve graft
greater auricular, for facial nerve repair,
521, 1248-1249, 1248f, 1268, 1371,
1372f
hypoglossal-facial, for facial reanimation,
840
sural, for facial nerve repair, 521, 1252,
1252f, 1268
Nerve injury, histopathophysiologic
classifi cation of, 1257
Neurectomy, tympanic, for chronic parotitis,
518
Neurofi broma, macroglossia in, 162, 162f,
165, 165f
Neurofi bromatosis-2, 1298
Neuroma
acoustic. See Acoustic neuroma.
of facial nerve, 1241-1242, 1242f, 1243,
1244f. See also Facial nerve, tumor of.
cystic, 1245
stereotactic radiosurgery for, 1246
after prestyloid parapharyngeal space
tumor excision, 530
Neurophysiologic monitoring
in acoustic neuroma surgery, 1301, 1301f
of cervical spine, 712
Nevus
in basal cell nevus syndrome, 721
dysplastic, 722, 726
Spitz, 726
Nitinol, for stapes prosthesis, 1193
Nodules, vocal fold, 303
Nonsteroidal anti-infl ammatory drugs, after
tonsillectomy, 178
Nose. See Nasal entries.
Nosebleed. See Epistaxis.
Nylon foil implant, for orbital
reconstruction, 943
Nystagmus, in perilymphatic fi stula, 1220
O
Occlusion, Angle’s classifi cation of, 886,
887f
Odontoid process
anatomy of, 1069
resection of, 1069
in transnasal procedures, 1071, 1072f
Ohngren’s line, 77, 78f
Olfactory fossa, depth of, classifi cation of,
96f
Omohyoid muscle
anatomy of, 683, 683f
in radical neck dissection, 694, 694f
Onlay graft, for skull defect repair, 134, 134f
Onodi cells, 96, 96f, 1047
Opioids, after tonsillectomy, 178
Optic foramen, drilling of, in optic nerve
decompression, 958, 958f
Optic nerve, 100
dehiscence of, in sphenoid sinus, 140,
140f
injury to
classifi cation of, 955
during endonasal surgery, 1051
after medial maxillectomy and lateral
rhinotomy, 72-73
orbital decompression in, 950
traumatic, 939
diagnosis of, 955
imaging of, 955-956, 956f, 957f
treatment of, 955
Optic nerve decompression
complications of, 959-960
indications for, 957
pearls and pitfalls in, 960
postoperative management of, 959
preoperative planning for, 955-957, 956f,
957f
surgical technique for, 957-959, 957f-959f
Optic strut, pneumatization of, in optic
nerve decompression, 957f, 958
Optic-carotid recess, 1046, 1047f
Oral cavity
cancer of. See also specifi c anatomic site, e.g.,
Tongue cancer.
marginal mandibulectomy for, 255-260
treatment principles for, 217-218
fl oor of. See Mouth entries.
Oral lichen planus, skin cancer in, 722
Oral retraining device, for obstructive sleep
apnea, 151
Oral-antral fi stula, 63-66
closure of
patient selection for, 63
pearls and pitfalls in, 66
postoperative management in, 65-66
preoperative evaluation in, 63, 64f
techniques for, 63-65, 65f-66f
etiology of, 63, 64f
recurrent, 66
Oral-nasal fi stula, after hard palate cancer
surgery, 215
Oral-nasal separation, loss of, rehabilitation
for, 211-214, 213f-214f, 288, 289f. See
also Speech rehabilitation.
Orbicularis oris, in unilateral cleft lip repair,
770-771, 771f-772f
Orbit
abscess of, 950, 950f
postoperative, 140-141, 141f
anatomy of, 935, 936f, 948-949, 949f, 968f
benign disease of, 961-962
infection of
fungal, 961
postoperative, 140-141, 141f
injury to, 878-879, 879f, 880f
after medial maxillectomy and lateral
rhinotomy, 72-73
Orbit (Continued)
malignant tumor of, 961, 962f
reconstruction of, 1064-1065, 1067f
Orbital apex, exposure of, transorbital
approach to, 1015, 1017, 1017f-1018f
Orbital apex syndrome, 908
Orbital decompression, 947-953
anatomic considerations in, 948-949, 949f
complications of, 953
lateral wall, 952, 952f
medial wall, 146, 146f, 951-952
for orbital abscess, 140-141, 141f
patient selection for, 949-951, 950f
pearls and pitfalls in, 953
postoperative care in, 952-953
preoperative evaluation and planning for,
951
for retrobulbar hemorrhage, 139-140, 140f
surgical approaches to, 951-952
Orbital emphysema, postoperative, 141, 142f
Orbital exenteration, 961-966
in anterior cranial base tumor, 983
complications of, 965
lid-sparing, 962, 963f, 964
patient selection for, 961-962, 962f
pearls and pitfalls in, 965-966
preoperative evaluation for, 962
reconstructive options for, 962f, 963
surgical approaches to, 962-965
technique of, 83-84, 963-965, 963f-965f
total maxillectomy with, 81-84
reconstruction of, 86-88, 86f-88f
Orbital fat
pseudoherniation of, 857
removal of
in lower lid blepharoplasty, 862-863,
863f, 865, 866f
in upper blepharoplasty, 860f, 861
Orbital fracture
blowout, 908, 936, 937-939, 937f-939f
of fl oor, 940-943, 941f-943f
of medial wall, 943
involving fl oor, 908-909, 909f, 915, 917f,
918, 919f-920f, 920
involving roof, 908, 943
preoperative evaluation of, 907-909, 909f,
939-940
surgical repair of
determination of need for, 937-939,
937f-939f
early, contraindications to, 939
implant material for, 943
implant placement in, 942, 942f
patient selection for, 935-939
pearls and pitfalls in, 944-945
postoperative management of, 931,
943-944, 944f
techniques for, 915, 917f, 918, 919f-
922f, 940-943, 941f-943f
theories of, 937
types of, 935-937
Orbital reconstruction
after exenteration, 962f, 963
implant material for, 943
implant placement in, 942, 942f
Orbital wall resection, in anterior cranial
base surgery, 989, 989f
Orbitozygomatic osteotomy
in anterior transfacial infratemporal fossa
surgery, 1014, 1015f

I-24
Index
Volume 1: pages 1-718
Volume 2: pages 719-1410
Orbitozygomatic osteotomy (Continued)
in preauricular (subtemporal)
infratemporal fossa surgery, 1004,
1004f, 1005, 1005f, 1006f
and temporal craniotomy, exposure after,
1007f
in transorbital infratemporal fossa surgery,
1015, 1017f
Oropharyngeal disproportion, in obstructive
sleep apnea, 153, 153f
Oropharynx, cancer of
metastasis of, 283-284, 285f
neck dissection in, 283, 287
transoral excision of, 283-289
patient selection for, 284-285, 285f
postoperative management of, 287-288,
289f
preoperative evaluation for, 285
technique of, 286-287, 286f-288f
treatment principles for, 217-218
Orotracheal injector device, 296
Orthognathic surgery, cleft, 788-789, 789f
Orthopedic devices, presurgical, for facial
clefts, 768-769, 769f
Oscillators, prosthetic, for speech
rehabilitation, 431, 432f
Ossicular chain, inspection and palpation of,
in tympanoplasty, 1140, 1141f
Ossicular chain reconstruction, 1147-1162
patient selection for, 1148-1150, 1149f
pearls and pitfalls in, 1161-1162
postoperative management of, 1161
preoperative planning for, 1150
prosthesis options and adjunctive
techniques in, 1150-1151, 1151f,
1152f, 1155, 1156f
surgical techniques in, 1151-1161
for footplate abnormalities, 1160-1161,
1160f
for incus abnormalities, 1152-1157,
1152f-1158f
for malleus abnormalities, 1159-1160,
1160f
for stapes abnormalities, 1157-1158,
1158f-1159f
tympanomeatal incision in, 1151, 1151f
Ossicular dislocation, during stapes surgery,
1204
Ossiculoplasty, in atresia repair, 1118
Osteochondral graft, for midline nasal
support, 829, 832f
Osteocutaneous fl ap
fi bular, 742-744, 744f
iliac crest, 744-745, 745f
Osteogenesis imperfecta, otosclerosis
associated with, 1191
Osteoma
of ethmoid sinus, 99, 100f
of external auditory canal, 1099, 1100f
complications of, 1105
postoperative management of,
1104-1105
preoperative planning for, 1100-1101,
1101f
surgical management of, 1101, 1102f
of frontal sinus, 113, 114f
Osteomyelitis, after external frontal sinus
surgery, 118-119
Osteophytes, of cervical spine, 710, 711f
Osteotomes, in rhinoplasty, 811, 811f
Osteotomies
in anterior cranial base surgery, 989, 989f,
993
in anterior marginal mandibulectomy, 246
in anterior transfacial infratemporal fossa
surgery, 1014, 1015f
in cleft orthognathic surgery, 789, 789f
in frontal sinusotomy with fat obliteration,
116, 117f
in inferior maxillectomy, 210
mandibular, 277-282, 278f-281f. See also
Mandibulotomy; Midline
labiomandibuloglossotomy.
in marginal mandibulectomy, 259, 259f
in maxillomandibular advancement
surgery, 157, 157f
in medial maxillectomy and lateral
rhinotomy, 70, 71f
in partial lateral maxillectomy, 209-210,
209f
in preauricular (subtemporal)
infratemporal fossa surgery,
1004-1005, 1004f, 1005f, 1006f
in rhinoplasty, 811-812, 811f, 812f
in segmental mandibulectomy, 266,
270-271, 270f, 271f
in total maxillectomy with orbital
exenteration, 80, 80f, 81f, 84
in transpetrosal approach to cranial base
tumor, 1034, 1034f, 1035f
for tumor involvement of mandibular
alveolus, 249, 251f
Otalgia, in tongue cancer, 219
Otic capsule, anomalies of, perilymphatic
fi stula in, 1222, 1222f
Otitic hydrocephalus, 1236
Otitis externa
malignant, 1083, 1276-1277
recurrent, osteoma and, 1099, 1100
Otitis media
acute
with complications
preoperative planning for, 1126-1127
wide myringotomy with tube
placement for, 1125
diagnostic tympanocentesis in, 1126
facial paralysis in, 1260
myringotomy alone for, 1125, 1126
recurrent, myringotomy with tube
placement for, 1125
brain abscess in, 1235-1236, 1236f
chronic
cerebrospinal fl uid otorrhea in, 1360
facial paralysis in, 1260-1261
with effusion
biofi lm in, 1124
chronic, adenoidectomy for, 34
myringotomy alone for, 1125
in patients with cleft palate, 780-781
treatment of
in adults, 1125
in children, 1124-1125
tympanostomy tube placement for,
1125, 1126
epidural abscess in, 1232-1233, 1233f
intracranial complications of, 1229-1238,
1230t-1231t, 1232f
lateral sinus thrombosis in, 1233,
1234f-1235f
meningitis in, 1229, 1232, 1232f
Otitis media (Continued)
otitic hydrocephalus in, 1236
petrous apicitis in, 1025-1026, 1025f
sepsis and, 1126
subdural abscess in, 1234-1235
vaccination for prevention of, 1124
Otology, offi ce-based procedures in,
1075-1091
Otoplasty, 791-797
complications of, 795-796
patient selection for, 791, 792f, 793f
pearls and pitfalls in, 796
postoperative management of, 795
preoperative planning for, 791-792
surgical techniques for, 792-795, 793f-795f
Otorrhea
cerebrospinal fl uid. See Cerebrospinal
fl uid otorrhea.
after tympanostomy tube placement,
1129-1130
Otosclerosis, 1189-1208
differential diagnosis of, 1190-1191
round window, 1204
surgical management of
anesthesia for, 1192, 1193-1194
in children, 1191-1192
complications of, 1203-1207,
1203f-1206f
determination of pathology in, 1194
expected results of, 1202
exposure in, 1193, 1194f, 1195f
footplate removal in, 1196
obliterative disease and, 1202, 1202f
patient evaluation and selection for,
1189-1192, 1190f
patient positioning in, 1193
pearls and pitfalls in, 1207-1208
postoperative care after, 1203
preoperative planning for, 1192
revision, 1200-1202
stapedectomy in
conventional, 1196-1199, 1196f-1199f
laser-assisted, 1199-1200, 1200f-1201f
Oxygen therapy, hyperbaric, tympanostomy
tube placement after, 1126
Oxymetazoline
for endoscopic maxillary sinus surgery, 53,
53f
for intranasal ethmoidectomy, 101
for nasopharyngeal anesthesia, 295
for optic nerve decompression, 957
for transnasal esophagoscopy, 446
P
Packing. See Ear packing; Nasal packing.
Paget’s disease, otosclerosis associated with,
1191
Painful shoulder syndrome, after neck
dissection, 683, 706
Palatal fi stula, repair of, 785-787
Palatal mucosal fl ap, for oral-antral fi stula,
64-65, 65f
Palate
anatomy of, 781f
cleft. See Cleft palate.
defects of
classifi cation of, 213, 213t
reconstruction of, 211-214
free fl aps for, 209, 213-214, 743f, 749

Index
I-25
Volume 1: pages 1-718
Volume 2: pages 719-1410
Palate (Continued)
local fl aps for, 213
prosthesis in, 212-213, 213f
regional fl aps for, 213, 214f
tissue, 86
dysfunction of, after transoral/transpalatal
procedures, 1073
hard. See Hard palate.
soft. See Soft palate.
Palatine tonsils, 169-170, 170f
removal of. See Tonsillectomy.
Palatomaxillary defects, classifi cation of, 213,
213t
Palatoplasty
Furlow, 778-780, 779f
revision, for velopharyngeal
incompetence, 785
two-fl ap, with intravelar veloplasty,
776-778, 777f
velopharyngeal incompetence after,
781-782, 781f
Panendoscopy
in fl oor of mouth cancer, 244
in tongue base and hypopharyngeal
tumor, 236
Pannus
resection of, in transnasal procedures,
1071
rheumatoid, 1070, 1070f
Pansinusitis, 113
Papillary carcinoma, arising in thyroglossal
duct cyst, 636-637, 636f
Papilloma, inverted
endoscopic biopsy of, 4
of sinonasal tract, medial maxillectomy
and lateral rhinotomy for, 67, 68, 69f
Papillomatosis
laryngeal, tracheostomy in, 578, 578f
recurrent respiratory, 323-327, 324f-326f
Paraganglioma. See Glomus tumor.
Paraglottic space, cancer involving, 396,
396f, 397f
Paralysis
facial. See Facial paralysis.
vocal fold. See Vocal fold, immobility/
paralysis of.
Paranasal sinuses. See also specifi c sinus, e.g.,
Ethmoid sinus.
blood supply to, 143-144, 144f-145f
tumor of, medial maxillectomy for, 68, 68f
Parapharyngeal space abscess, 671-672,
672f-673f, 675f, 676, 676f
Parapharyngeal space tumor, 657-669
anatomic considerations in, 657-660, 658f,
659f
complications of, 668-669
histologic diagnosis of, 659t
metastatic, 657, 660
pearls and pitfalls in, 669
poststyloid, 525, 527f, 664-668
anatomic considerations in, 657
excision of
complications of, 669
indications for, 666-667
techniques for, 667-668, 667f, 668f
types of, 664-666, 665f
preoperative evaluation of, 660-661, 661t
prestyloid
anatomic considerations in, 525, 526f,
657, 658f, 659f
Parapharyngeal space tumor (Continued)
excision of, 525-531, 661-664
complications of, 530-531, 668-669
mandibulotomy for, 663-664
parotid-submandibular incision for,
662-663, 663f-664f
patient selection for, 525, 527f
postoperative management after, 530
techniques for, 528-530, 528f-530f
transcervical submandibular
approach in, 661, 662f
transoral, 530-531, 561
fi ne-needle aspiration biopsy of, 528
preoperative evaluation of, 525,
527f-528f, 528
signs and symptoms of, 660, 660f, 660t
surgical approaches to, 661, 661t
Parascapular fasciocutaneous fl ap, 741
Parascapular free fl ap, 741
Parathyroid glands, identifi cation of, in
thyroid lobectomy, 548f, 549
Parathyroidectomy, 559-564
approach to “localizing gland” in, 560-561,
560f-561f
approach to “nonlocalizing gland” in,
561
ectopic and nonectopic parathyroid tissue
locations in, 561-563, 562f-563f
endoscopic subtotal, 552
patient selection for, 559
pearls and pitfalls in, 564
postoperative management of, 563
preoperative planning for, 559-560
Parotid gland
accessory lobe of
anatomy of, 533
tumor of, 533, 535f
enlarged, in systemic disease, 513, 513f
injury to
Frey’s syndrome after, 496
traumatic, 879, 881
tumor of
benign, 511
in buccal space, 535
computed tomography of, 512, 512f,
517, 518f
fi ne-needle aspiration biopsy of, 512,
633
malignant, 511-512, 512f
open biopsy of, 513
in parapharyngeal space, 525, 527f,
528f
Parotidectomy, 511-522
facial nerve repair after, 521-522,
521f-522f
in fi rst branchial cleft remnant excision,
650-651
Frey’s syndrome after, 496, 516
patient selection for, 511-512, 512f
pearls and pitfalls in, 522
preoperative evaluation for, 512-513,
512f-513f
radical, 519-521, 520f-521f
for sialoadenitis, 487
superfi cial lobe
approaches to, 513-515, 514f
postoperative management and
complications of, 515-517, 517f
prestyloid parapharyngeal space tumor
excision with, 529, 530f
Parotidectomy (Continued)
temporal bone resection in combination
with, 1276
total, with facial nerve dissection, 517-519,
518f-519f
Parotid-submandibular incision, extended,
for buccal space tumor excision,
536-537, 537f-538f
Parotitis, chronic, 518
Particle repositioning, for benign
paroxysmal positional vertigo, 1394
Passavant’s ridge, 33
Passey-Muir valve, 582
Patient education, after skin cancer surgery,
735-736
Pectoralis major myocutaneous fl ap
complications of, 756
for glossectomy defects, 744f, 747
after lateral pharyngotomy, 239
overview of, 753-756, 754f-755f
after segmental mandibulectomy, 273
skin island for, 755
after total glossectomy, 223-224, 223f
Pectoralis myofascial graft, after lateral
pharyngotomy, 239
Pedicle fl ap, 753-763
cervicopectoral, 762, 762f
deltopectoral, 761, 761f
latissimus dorsi, 756-757, 756f
pearls and pitfalls in, 762-763
pectoralis major, 753-756, 754f-755f. See
also Pectoralis major myocutaneous
fl ap.
sternocleidomastoid, 757
temporalis, 759-761, 760f
temporoparietal fascial, 758-759, 760f
trapezius, 757-758, 758f
Percutaneous dilatational tracheostomy,
585-593, 588f-591f
Pericranial fl ap, in anterior cranial base
reconstruction, 990-991, 990f-991f,
1061-1062, 1062f-1063f
Perilymphatic fi stula, 1219-1227
causes of, 1219-1220
cerebrospinal fl uid leak in, 1359
post-traumatic, 1219, 1220
revision stapes surgery for, 1201
spontaneous, 1219
after stapedectomy, 1207, 1224, 1224f
surgical management of
complications of, 1226
patient selection for, 1220-1222,
1221f-1222f
pearls and pitfalls in, 1226
postoperative care after, 1226
preoperative planning for, 1222-1223
techniques in, 1223-1226, 1223f-1226f
Perilymphatic gusher
management of, 1182, 1186
in middle ear reconstruction, 1178
in stapes surgery, 1204
Periorbita
cancer of, 727-728
elevation of
in anterior cranial base surgery, 986-987
in preauricular (subtemporal)
infratemporal fossa surgery, 1005,
1006f
injury to, 878-879, 879f, 880f
repair of, 729

I-26
Index
Volume 1: pages 1-718
Volume 2: pages 719-1410
Periosteum, elevation of, in medial
maxillectomy and lateral rhinotomy, 69,
70f
Peripheral vestibulopathy, uncompensated,
vertigo in, 1394-1395
Peritonsillar abscess, 169, 672, 673f
tonsillectomy for, 177-178
Per-Lee tube, for middle ear drainage, 1129,
1129f
PET/CT. See Positron emission tomography/
computed tomography (PET/CT).
Petroclival tumor
nonsurgical management of, 1023
preoperative evaluation of, 1026-1027
types of, 1023
Petrosal approach to cranial base tumor,
1023-1043
anterior
indications for, 1024-1025
technique of, 1027-1032, 1027f-1033f
expanded endoscopic nasal (endonasal),
1026, 1039-1040
middle fossa, 1024-1025
technique of, 1027-1032, 1027f-1031f
overview of, 1023-1024, 1024t
partial labyrinthine, 1025, 1037, 1037f
patient selection for, 1024-1026, 1024f
pearls and pitfalls in, 1042-1043
petrous apicetomy in, 1025, 1032,
1032f-1033f
posterior (transpetrosal)
indications for, 1025-1026
technique of, 1032-1039, 1033f-1039f
postoperative care and complications of,
1041-1042
preoperative planning for, 1026-1027
reconstruction after, 1040
retrolabyrinthine, 1025, 1036-1037,
1036f
transcochlear, 1025-1026
and total petrosectomy, 1038-1039,
1038f-1039f
translabyrinthine, 1025, 1038
Petrosal nerve, greater superfi cial, 1308,
1308f
in middle fossa approach, 1030, 1031,
1031f, 1264, 1264f
Petrosal vein, 1311
Petrosectomy, total, 1038-1039,
1038f-1039f
Petrositis, chronic, 1276
Petrous apex
access to, 1338
anatomy of, 1337-1338, 1338f
drainage approaches to, 1338, 1338f
lesions of, 1338-1341, 1340f. See also
Temporal bone, cholesterol
granuloma and epidermoid tumor of.
Petrous apicetomy
indications for, 1025
technique of, 1032, 1032f-1033f
Petrous apicitis, in otitis media, 1025-1026,
1025f
Pharyngeal closure, in total laryngectomy,
428, 428f-429f
Pharyngeal constrictor muscles, release of,
in laryngectomy, 403, 404f
Pharyngeal fl ap, for velopharyngeal
incompetence, 783, 784f-785f
Pharyngeal tonsils. See Adenoid(s).
Pharyngectomy, 467-471
defect after, free fl ap for, 746f, 748, 748f
patient selection for, 467-469, 468f-469f
pearls and pitfalls in, 471
surgical approaches to, 469-470, 470f, 471f
Pharyngocutaneous fi stula
after arytenoid adduction, 333
after lateral pharyngotomy, 239-240
Pharyngoesophageal diverticulum, 459-465,
460f-464f. See also Zenker’s diverticulum.
Pharyngogastric anastomosis, gastric
transposition and, esophageal
reconstruction with, 480, 480f
Pharyngolaryngoesophagectomy. See
Laryngopharyngoesophagectomy.
Pharyngolaryngoscopy, before
esophagoscopy, 444, 444f
Pharyngoplasty, sphincter, for
velopharyngeal incompetence, 783, 785,
786f
Pharyngotomy
lateral, 235-240
inferior extension of, 238, 239f
preoperative assessment in, 235-236,
236f
for total glossectomy, 225, 225f
transhyoid, 469, 469f
in cervical esophageal cancer surgery,
478, 479f
Pharynx. See also Hypopharynx;
Nasopharynx; Oropharynx.
reconstruction of, 468
Phenol, for topical application to tympanic
membrane, 1076, 1076f
Pheochromocytoma, 667
Phonation, myoelastic aerodynamic theory
of, 305
Phonomicrosurgery, 303-309
anesthesia for, 305
complications of, 309
equipment for, 306, 307f
microfl ap technique in, 306, 308f, 309f
patient positioning in, 305-306, 305f
patient selection for, 303-304
pearls and pitfalls in, 309
postoperative management of, 306,
308-309
preoperative evaluation for, 304-305
truncation technique in, 306, 309f
Photodynamic therapy, for recurrent
respiratory papillomatosis, 327
Phrenic nerve
anatomy of, 683f, 684-685
injury to, in neck dissection, 704
in radical neck dissection, 694, 694f
“Pie-crusting” technique, for suturing skin
graft to fl oor of mouth, 246, 246f
Pinna
cancer of, 1271-1272. See also Temporal
bone carcinoma.
reconstruction of, before atresia repair,
1115
Piriform aperture, wiring of, in maxillary
arch bar, 889, 891f
Piriform sinus
cancer involving, 468, 468f, 470, 470f
fi stula of, 653, 655f
tumor of, superior, partial
laryngopharyngectomy for, 408-409,
409f
Piriform sinus pharyngotomy, 238, 239f
Pituitary tumor, endonasal approach to,
1045-1051. See also Sella/parasellar
areas, endonasal approach to.
Plate fi xation
of free cartilage graft for posterior cricoid
area, 370, 372f
in laryngeal trauma repair, 354, 354f, 355f
in laryngofi ssure, 336-337, 336f, 338f
in mandibular advancement surgery, 156,
157f
in mandibulotomy, 279, 279f
maxillomandibular, for mandibular
fracture, 888-889, 889f-891f
in midline labiomandibuloglossotomy,
280, 281f
in segmental mandibulectomy, 269
Platysma muscle, anatomy of, 681, 681f
Pneumatic compression stockings,
perioperative use of, in anterior cranial
base surgery, 984
Pneumatic fi stula test, in perilymphatic
fi stula, 1221
Pneumocephalus, tension
after anterior cranial base surgery, 995,
995f
after cranial base reconstruction,
1066-1067
after petrosal approach to cranial base
tumor, 1042
Pneumococcal vaccine, in cochlear implant
candidate, 1379, 1379t
Pneumomediastinum
during percutaneous dilatational
tracheostomy, 592
during tracheostomy, 583-584
Pneumonia, aspiration, recurrent, 595, 596
Pneumothorax
during percutaneous dilatational
tracheostomy, 592
during tracheostomy, 583, 583f
Pollybeak deformity, after rhinoplasty, 818
Polymorphic reticulosis, of hard palate,
205
Polyneuropathy, amyloid, lip biopsy in, 491
Polyp
antrochoanal. See Antrochoanal polyp.
of cervical esophagus, 474
vocal fold, 303
Polypectomy, nasal, 100-101, 100f
Polysomnography, in obstructive sleep
apnea, 152, 177
PORP (partial ossicular replacement
prosthesis), 1148, 1151, 1151f, 1152f
Positive-pressure ventilation, during rigid
bronchoscopy, 572
Positron emission tomography with fl uoro-2-
deoxyglucose (FDG-PET), in
parapharyngeal space tumor, 661
Positron emission tomography/computed
tomography (PET/CT)
in branchial cleft remnants, 649
in cervical esophageal cancer, 477
in fl oor of mouth cancer, 244
in hard palate cancer, 207
in lip cancer, 185
in neck cancer staging, 688
in thyroid cancer, 545-546, 546f
in tongue base and hypopharyngeal
tumor, 235, 236f

Index
I-27
Volume 1: pages 1-718
Volume 2: pages 719-1410
Postauricular abscess, 1081, 1082, 1082f
Postauricular (transtemporal) approach, in
infratemporal fossa surgery, 1008-1009,
1011f-1013f
Postauricular incision
for atresia repair, 1116, 1116f, 1120, 1120f
for canal wall reconstruction, 1109, 1109f
for exostoses surgery, 1101-1102, 1103f
for foreign body removal from ear,
1096-1097, 1096f
for glomus jugulare tumor surgery, 1328,
1328f
for mastoidectomy, 1166, 1166f
Postauricular skin fl ap, in rhytidectomy, 849,
849f, 852, 852f
Postcricoid mucosa, 467
cancer involving, 468-469, 469f
Posterior commissure
recurrent respiratory papillomatosis
removal from, 326, 326f
webbing of, laryngofi ssure for, 335-336
Posterior fossa vestibular nerve section,
1400
Posterior scar–microtrapdoor fl ap, for
posterior glottic stenosis, 314
Posterior triangle, second branchial cleft
remnant in, 647, 647f
Post-paralytic synkinesis, 1386, 1386t
Poststyloid parapharyngeal space tumor. See
Parapharyngeal space tumor,
poststyloid.
Posttragal incision, for rhytidectomy, 846
Potassium titanyl phosphate (KTP) laser,
383
Pott’s puffy tumor, 118, 118f
Powered instrumentation
for choanal atresia repair, 28-29
for endoscopic maxillary sinus surgery,
55
for intranasal ethmoidectomy, 101-102
for tonsillectomy, 173
Preauricular (subtemporal) approach, in
infratemporal fossa surgery, 1002-1008,
1002f-1011f
Preauricular skin fl ap, in rhytidectomy,
849-850, 849f, 850f, 851-852, 851f-852f
Preauricular subtemporal infratemporal
approach, to temporal bone cholesterol
granuloma and epidermoid tumor,
1351-1353, 1352f-1353f
Prednisone
for Bell’s palsy, 1259
after ethmoid sinus endoscopic surgery,
97
for facial paralysis, 1260, 1368
for Graves’ orbitopathy, 950
Pressure dressings
after facial repair, 877, 932
for rhytidectomy, 853
Pressure equalization tube. See
Tympanostomy tube.
Prestyloid parapharyngeal space tumor. See
Parapharyngeal space tumor, prestyloid.
Pretragal incision, for rhytidectomy, 846
Prevertebral space, 709
abscess in, 673-674, 674f
Projection control sutures, in rhinoplasty,
817
Proptosis, orbital decompression for,
947-953
Prosthesis
for ear reconstruction, 729
maxillofacial
for soft palate reconstruction, 200,
201-202
after total maxillectomy, 78-79, 81, 84f,
85, 85f
for middle ear reconstruction, 1179-1180
nasal, 821, 822f
ossicular replacement
options for, 1150-1151, 1151f, 1152f,
1155, 1156f
partial, 1148, 1151, 1151f, 1152f
total, 1147, 1148f, 1158, 1159f, 1160,
1160f
palatal, 212-213, 213f
after segmental mandibulectomy, 268
stapes, 1192-1193, 1193f
magnetic resonance imaging and, 1207
Robinson type, 1196, 1198, 1198f, 1199f
wire-piston, 1200, 1201f
Prosthetic oscillators, for speech
rehabilitation, 431, 432f
Pseudoaneurysm, of internal carotid artery,
145, 145f
Pterygoid canal, 144
Pterygoid fossa. See Infratemporal fossa.
Pterygopalatine fossa, exposure of, in
juvenile angiofi broma surgery, 45,
45f-46f
Ptosis
after blepharoplasty, 868-869
brow, blepharoplasty and, 857
eyelid, blepharoplasty and, 858
Pulmonary embolism, after petrosal
approach to cranial base tumor, 1042
Q
“Question mark” incision, for postauricular
(transtemporal) infratemporal fossa
surgery, 1008, 1011f
Quinolones, for tympanostomy tube
otorrhea, 1129-1130
Quinsy tonsillectomy, 178
R
Rabies, from animal bites, 874
Radial forearm fasciocutaneous fl ap,
739-740, 740f
for nasal lining, 828, 831f
for pharyngectomy defect, 748, 748f
Radial forearm free fl ap, 739-740, 740f
for nasal lining, 828, 831f
for pharyngectomy defect, 748, 748f
for total laryngopharyngectomy defect,
470, 471f
Radiation exposure, thyroid cancer and, 542
Radiation therapy. See also
Chemoradiotherapy.
for acoustic neuroma, 1296
for angiosarcoma, 726
for chronic parotitis, 518
for fl oor of mouth cancer, 242
for glomus tumor, 1321
for Graves’ orbitopathy, 950
for hard palate cancer, 207
for juvenile angiofi broma, 42-43
for laryngeal carcinoma, 380, 422
Radiation therapy (Continued)
for lip cancer, 185
for neck cancer, 690
for skin cancer, 720-721
for soft palate cancer, 199, 202
for temporal bone carcinoma, 1276
Radiesse Voice Gel, for vocal fold
augmentation/injection, 319
Radiofrequency ablation, for tonsillectomy,
172
Radiography
in evaluation of bone invasion, 258
after facial fracture repair, 932
in frontal sinusitis, 113, 114f
in mandibular fracture, 887
in submandibular calculi, 506, 506f
in zygomatic complex fracture, 907
Radionuclide scanning
in thyroglossal duct cyst, 637-638
in thyroid cancer, 544
Radiosurgery, stereotactic
for acoustic neuroma, 1297
for facial nerve tumor, 1246, 1252-1253,
1253f
for glomus tumor, 1324-1325, 1325f
Ramus mandibularis defect, digastric muscle
transposition for, 841, 841f
Ranula
congenital, 501, 502f
plunging, 499-500, 500f, 501f, 503-504,
503f
recurrent, 504
surgical management of, 499-504,
500f-503f
therapeutic options for, 500-501
Reanimation
eye, 973-977. See also Eye reanimation.
facial, 839-843. See also Facial reanimation.
Rectus abdominis free fl ap, 742, 743f
in orbital exenteration, 964f, 965
Rectus muscle, inferior, trapped, in
orbital blowout fracture, 937-938,
937f
Rectus muscle, medial, injury to, from
microdébrider, 139
Reduction
dorsal
complications of, 818
in nasal tip surgery, 814
in rhinoplasty, 810-812, 811f-812f
of nasal fracture, 920, 923f
open, of condyle fracture, 898
tongue. See Macroglossia, reduction
procedures for.
turbinate. See Turbinate reduction.
Refl ex testing, stapes, in facial nerve tumor,
1246
Refl ux disease
laryngeal stenosis in, 360, 360f
tracheal stenosis in, 604
Regional fl ap, for palatal defect repair, 213,
214f
Regional pedicle fl ap. See Pedicle fl ap.
Rehabilitation
dental, after marginal mandibulectomy,
256, 257f, 258f
prosthetic, after segmental
mandibulectomy, 268
speech. See Speech rehabilitation.
Reinke’s edema, 303

I-28
Index
Volume 1: pages 1-718
Volume 2: pages 719-1410
Relaxing skin tension lines (RSTLs), in
facial soft tissue injury repair, 872,
875
Respiratory papillomatosis, recurrent,
323-327
adjunctive therapy for, 326-327
appearance of, 323, 324f
complications of, 327
laryngofi ssure and, 335
patient selection for, 323-324
pearls and pitfalls in, 327
postoperative management of, 327
preoperative planning for, 324
surgical technique for, 324-326, 325f-326f
Retractor, for transoral/transpalatal surgery,
1071, 1071f
Retrobulbar hemorrhage, after endoscopic
sinus surgery, 139-140, 140f
Retrofacial infralabyrinthine approach, to
temporal bone cholesterol granuloma
and epidermoid tumor, 1348-1349,
1349f
Retrolabyrinthine petrosal approach to
cranial base tumor, 1025, 1036-1037,
1036f
Retrolabyrinthine vestibular nerve section,
1400-1403, 1401f-1403f, 1409
Retromolar trigone cancer, marginal
mandibulectomy for, 255, 256f
Retropharyngeal abscess, third branchial
cleft remnant with, 653, 655f
Retropharyngeal lymph nodes, 709, 711f
Retropharyngeal space, 709
abscess in, 672-673, 673f, 676
Retrosigmoid approach
to acoustic neuroma, 1298, 1309-1313,
1310f-1313f
to facial nerve tumor, 1252
Retrosigmoid vestibular nerve section,
1404-1405, 1404f-1405f, 1409
Rhinitis
allergic, diagnostic endoscopy in, 1
atrophic, with septal perforation, 3
Rhinitis medicamentosa, 17-18
diagnostic endoscopy in, 2
Rhino-orbital-cerebral mucormycosis, 961
Rhinoplasty, 807-819
anesthesia for, 808
cleft, 788
complications of, 818
dorsal reduction/profi le alignment/
osteotomies in, 810-812, 811f-812f
dressings for, 817-818
endonasal approaches to, 808
external approaches to, 808-810,
808f-810f
fi ve-cornered transcolumellar inverted-V
incision for, 808, 808f, 809f
marginal incision for, 808, 808f, 809f
nasal tip surgery in, 812-817, 813f-817f
pearls and pitfalls in, 818-819
postoperative management of, 817-818
preoperative planning for, 807
Rhinorrhea
cerebrospinal fl uid. See Cerebrospinal
fl uid rhinorrhea.
differential diagnosis of, 132
postoperative, differential diagnosis of,
1054
Rhinosinusitis, eosinophilic mucin, 3
Rhinotomy, lateral
in anterior cranial base surgery, 984, 984f
medial maxillectomy through, 67-73
complications of, 72-73, 73f
patient selection for, 68, 69f
postoperative management of, 72
preoperative planning for, 68, 68f, 69f
technique of, 69-72, 69f-72f
total maxillectomy with orbital
exenteration through, 80, 80f, 81f
Rhytidectomy, 845-855
anesthesia for, 846
for buccal space tumor excision, 537-538
complications of, 855
dressings for, 853
markings for, 846-847, 847f-848f
pearls and pitfalls in, 855
postoperative management of, 854, 854f
preoperative planning for, 845-847
skin redraping in, 851-852, 851f-852f
SMAS (submuscular aponeurotic system)
suspension in, 850-851, 851f
surgical technique for, 847-853, 848f-853f
Rib cartilage graft, for microtia
reconstruction, 798-799, 798f-800f
Robinson prosthesis, 1196, 1198, 1198f,
1199f
Bailey modifi cation of, 1198
Rongeur, in choanal atresia repair, 30, 31f
Rosebud packing
after exostoses removal, 1103, 1104, 1104f
after tympanoplasty, 1143, 1143f, 1144f
Rotation fl ap, cheek, 733, 735f
Round window
absence of, 1186
otosclerosis of, 1204
Rubin osteotome, in rhinoplasty, 811, 811f
S
Saddle nose deformity, after septoplasty, 25
St. Clair Thompson forceps, for
adenoidectomy, 36, 36f
Salivary duct calculi, removal of, 485-489
endoscopic, 486, 486f, 487, 489, 489f
external, 487-489, 487f-488f
patient selection for, 485-487, 486f
pearls and pitfalls in, 489
Salivary gland(s)
minor
of lip, biopsy of, 491-493, 492f-493f
tumor of, 199
in buccal space, 535-536
in parapharyngeal space, 525, 528
parotid. See Parotid gland.
sublingual, ranula in, surgical
management of, 499-504, 500f-503f
submandibular. See Submandibular gland.
tumor of
in buccal space, 535
fi ne-needle aspiration biopsy of, 633
Santorini, fi ssures of, 1272, 1274f
Sarcoidosis, laryngeal stenosis in, 359, 359f
Scalp
cancer on, 728, 732
elevation of
in anterior cranial base surgery,
986-987, 986f, 987f
in anterior transfacial infratemporal
fossa surgery, 1014, 1015f
Scalp (Continued)
injury to, 882-883, 883f
layers of, 1028f
Scalp fl ap
in anterior cranial base reconstruction,
990-991, 990f-991f
necrosis of, 1019, 1020f, 1065-1066
in preauricular (subtemporal)
infratemporal fossa surgery,
1002-1003, 1003f
in transorbital infratemporal fossa surgery,
1015, 1017f
Scalp graft, for microtia reconstruction, 800,
801f
Scalp incision
for anterior cranial base surgery, 985-986,
985f, 986f
hemicoronal
for preauricular (subtemporal)
infratemporal fossa surgery, 1002,
1002f
with Weber-Fergusson incision, in
anterior transfacial approach, 1009,
1014, 1014f
for preauricular (subtemporal)
infratemporal fossa surgery, 1002,
1002f
Scapular fasciocutaneous fl ap, 741, 741f
Scapular free fl ap, 741, 741f
Scar
after laryngeal carcinoma endoscopic
surgery, 390
after superfi cial lobe parotidectomy, 516,
517f
tracheostomy, 617-621, 618f-620f
Scar revision, in facial soft tissue injuries,
878
Schwannoma
of superior cervical ganglion, 668
of vagus nerve, 668
vestibular. See Acoustic neuroma.
Scintigraphy, with indium-111, in
cerebrospinal fl uid rhinorrhea, 1054
Sebaceous carcinoma, of head and neck,
725
Seizure
after acoustic neuroma surgery, 1316
after anterior cranial base surgery, 995
features of, 1386t
after petrosal approach to cranial base
tumor, 1042
Sella, cerebrospinal fl uid rhinorrhea arising
from, 135
Sella/parasellar areas, endonasal approach
to, 1045-1051
anatomy in, 1045-1047, 1046f, 1047f
complications of, 1051
patient selection for, 1047
pearls and pitfalls in, 1051
postoperative care in, 1050-1051
preoperative evaluation for, 1047
preoperative planning for, 1047-1048
techniques for, 1048-1050, 1049f-1050f
Semicircular canal
fenestration of, in partial labyrinthectomy
approach to cranial base tumor,
1037, 1037f
posterior, occlusion of
complications of, 1408
for vertigo, 1396, 1396f

Index
I-29
Volume 1: pages 1-718
Volume 2: pages 719-1410
Semicircular canal (Continued)
superior, dehiscence of, 1178, 1190-1191,
1222, 1222f
surgery for, 1395, 1395f, 1407-1408,
1409
vertigo in, 1394, 1395f
Sentinel lymph node biopsy, 686-687
Senturia trap, tympanocentesis with,
1128-1129, 1129f
Sepsis, otitis media and, 1126
Septal cartilage, for nasal reconstruction,
830
Septal mucoperichondrial fl ap, for nasal
lining, 826f, 827
Septal mucosal fl ap, in endonasal approach
to sella/parasellar areas, 1048, 1050,
1050f
Septal pivot free fl ap, for nasal lining, 828,
832f
Septal splint, in septoplasty, 22, 22f
Septal spurs, 17
removal of, 21, 21f
Septectomy, in endonasal cranial base
surgery, 1039
Septic thrombophlebitis, of internal jugular
vein, 674, 674f, 676-677
Septocolumellar incision, 19-20, 20f, 74f
Septoplasty
complications of, 24-25
patient selection for, 17-18
pearls and pitfalls in, 25
postoperative management in, 24
preoperative planning for, 18-19, 19t
septocolumellar incisions for, 19-20, 20f
technique of, 19-23, 20f-22f
uvulopalatopharyngoplasty with, 152, 153
Septum, nasal. See Nasal septum.
Seroma
after glomus tumor surgery, 1334
after neck dissection, 705
Setback sutures, for otoplasty, 794-795
Shamblin classifi cation of carotid body
tumor, 664, 666, 666f
Shave resection, in thyroid surgery, 551
Shoulder syndrome, after neck dissection,
683, 706
Shunt
endolymphatic sac, for vertigo, 1397,
1398f
formation of, for speech rehabilitation,
432, 432f
SIADH (syndrome of inappropriate
antidiuretic hormone), after anterior
cranial base surgery, 994
Sialoadenitis
parotidectomy for, 487
submandibular gland excision for, 487
Sialocele
after superfi cial lobe parotidectomy, 516
traumatic, 879, 881
Sialoendoscopy, 486, 486f, 487, 489, 489f
Sialolithiasis. See Salivary duct calculi.
Silastic button, 5
Silastic material, for medialization
laryngoplasty, 331
Silastic sheeting, 1348, 1348f
for endolymphatic sac shunt, 1397, 1398f
Silastic splint, after endonasal surgery, 1051
Silastic stent, in choanal atresia repair, 30,
31f
Silicone stent, for tracheal stenosis, 606
Silver nitrate cautery stick, for anterior
epistaxis, 3
Sinolith, maxillary, computed tomography
of, 59, 59f
Sinonasal bleeding
after cranial base reconstruction, 1066
after optic nerve decompression, 959
Sinonasal disorders
offi ce-based diagnosis of, 1-3
offi ce-based procedures for, 3-5
Sinus surgery, endoscopic. See Endoscopic
sinus surgery.
Sinus thrombosis, lateral, in otitis media,
1233, 1234f-1235f
Sinusitis
bacterial
acute
endoscopically guided aspirate
culture of, 2
illustrated through endoscopic
middle meatal aspiration, 2
maxillary sinus tap in, 2
chronic
adenoidectomy for, 34
with biofi lm, 4-5
frontal, 113, 114f, 115f, 121
maxillary
imaging in, 59-60, 59f
odontogenic, oral-antral fi stula in, 63
surgical options for, 51-52, 52f
sphenoid, 108
Sinusotomy, frontal, with fat obliteration,
115-117, 116f-117f
Sistrunk procedure, for thyroglossal duct
cyst excision, 638-640, 640f-641f
Sjögren’s syndrome
diagnostic criteria for, 491, 492t
lip biopsy in, 491-493, 492f-493f
parotid gland enlargement in, 513, 513f
primary biliary cirrhosis and, 491-492
Skeletal support, in nasal reconstruction,
828-830, 832f, 833f
Skeletal surgery, for obstructive sleep apnea,
156-158, 156f-158f
Skin cancer, 719-736. See also specifi c type, e.g.,
Melanoma.
cryosurgery for, 720
curettage with electrodesiccation for, 720
diseases associated with, 722-723
laser surgery for, 720
Mohs surgery for, 721, 727
preoperative evaluation of, 723
radiation therapy for, 720-721
surgery for
alternatives to, 720-721
contraindications to, 720
follow-up in, 736
margin evaluation and, 726-727
patient education after, 735-736
patient selection for, 719-723
pearls and pitfalls in, 736
postoperative care in, 734-735
postoperative management after,
733-734
reconstruction after, 728-733, 730f-735f
tumor location and, 727-728
tumor type and, 723-726, 724f-725f
wound management after, open,
733-734
Skin cancer (Continued)
syndromes associated with, 721-722
topical chemotherapy for, 721
Skin fl ap
advancement
helical rim, for ear reconstruction, 729,
730f
wedge/block excision with, for large
tumors of the lip, 186-187, 189f,
190f
bilobed
for nasal reconstruction, 731, 732f
Zitelli’s, for nasal skin coverage, 832,
834, 835f
for bone-anchored hearing aid, 1210-
1211, 1211f
cervicopectoral, 762, 762f
in lateral temporal bone resection, 1280,
1280f
loss of, after radical neck dissection,
705-706
neck, in rhytidectomy, 848, 849f
necrosis of
after rhytidectomy, 855
after skin cancer surgery, 734-735
preauricular, in rhytidectomy, 849-850,
849f, 850f, 851-852, 851f-852f
smoking and, 821
for stomal stenosis revision surgery, 625,
626f-627f
Skin graft
for fl oor of mouth resurfacing, 246, 246f,
247, 247f
forehead fl ap with, for nasal lining, 828,
829f-830f
full-thickness, for nasal skin coverage, 830,
832
after lateral pharyngotomy, 239
necrosis of, after skin cancer surgery,
734-735
after oropharyngeal cancer excision, 287,
288f
split-thickness
in atresia repair, 1118, 1118f
for canal wall reconstruction, 1109-1110
in marginal mandibulectomy, 259-260,
260f
for microtia reconstruction, 800-801,
802f
in orbital exenteration, 102f, 963, 964
partial lateral maxillectomy and, 210,
210f
for reconstruction after temporal bone
resection, 1287, 1287f, 1288, 1289f
after segmental mandibulectomy, 272-
273, 273f
for tongue resurfacing, 222
after total maxillectomy, 80, 84f
after total maxillectomy with orbital
exenteration, 84
temporalis muscle transposition and, for
orbital and infratemporal skull base
defect, 1008, 1011f
Skin redraping, in rhytidectomy, 851-852,
851f-852f
Skin tension lines, relaxing, in facial soft
tissue injury repair, 872, 875
Skull base. See Cranial base entries.
Skull defect repair, free tissue graft for,
133-134, 133f-135f

I-30
Index
Volume 1: pages 1-718
Volume 2: pages 719-1410
Sleep apnea, obstructive
adenoidectomy for, 34
apneic index in, 151
after cleft palate repair, 783
continuous positive airway pressure for,
151, 152f
oral retraining device for, 151
oropharyngeal disproportion in, 153, 153f
overview of, 151-152, 152f
pearls and pitfalls in, 159
polysomnography in, 152
skeletal surgery for, 156-158, 156f-158f
surgery for, 151-159
tonsillectomy for, 177
tracheotomy for, 158-159
uvulopalatopharyngoplasty for, 153-156,
153f-156f. See also
Uvulopalatopharyngoplasty.
SMAS (submuscular aponeurotic system)
suspension, 850-851, 851f
Smile, reanimation of, 840-841, 841f
Smoking
Graves’ orbitopathy and, 947
laryngeal carcinoma and, 423
rhytidectomy and, 845
skin fl ap and, 821
“Sniffi ng” exercises, after recurrent
respiratory papillomatosis surgery, 327
Soft palate
cancer of, 199-202
radiation therapy for, 199, 202
surgery for
patient selection in, 199-200
pearls and pitfalls in, 202
postoperative management in,
201-202
preoperative evaluation in, 200,
201f
techniques in, 200-201, 201f-202f
transoral excision of, 283-289
types of, 199, 200f
reconstruction of, prosthesis in, 200,
201-202
Soft palate split, for juvenile angiofi broma
surgery, 44, 44f
Soft tissue injuries
in facial trauma, 871-884. See also Facial
soft tissue injuries.
in orbital fracture, 940
Solid organ transplantation, skin cancer
after, 722-723
Spasm, hemifacial. See Hemifacial spasm.
Spasmodic dysphonia, botulinum toxin
injection for, 293
Specimen handling, in fi ne-needle
aspiration biopsy, 632-633
Speech
abnormalities of, in patients with cleft
palate, 780, 780t
esophageal, 431
Speech rehabilitation, 431-437
contraindications to, 433
for loss of oral-nasal separation, 288,
289f
patient selection for, 432-433
pearls and pitfalls in, 437, 437f
postoperative care in, 437, 437f
preoperative evaluation for, 433-434
role of speech-language pathologist in,
432
Speech rehabilitation (Continued)
tracheoesophageal puncture for
primary, 434, 434f
secondary, 434-437, 435f-436f
types of, 431-432, 432f
Speech-language pathologist, 432
Sphenoid sinus
anatomic variations of, 1046-1047, 1047f
anatomy of, 1045, 1046f, 1047f
cerebrospinal fl uid rhinorrhea arising
from, 134-135, 135f, 1056-1057, 1057f
endonasal approach to, 1045-1051. See also
Sella/parasellar areas, endonasal
approach to.
fat obliteration of, for skull defect repair,
134-135, 135f
optic nerve dehiscence in, 140, 140f
surgical anatomy of, 107, 108f
tumor of, 108-109
Sphenoid sinus surgery, 107-112
complications of, 112
patient selection for, 107-109
pearls and pitfalls in, 112
postoperative management of, 112
preoperative planning for, 108f, 109, 109f
transnasal (endoscopic) approach to,
111-112
transseptal approach to, 109-111,
110f-111f
Sphenoid sinusitis, 108
Sphenoidotomy
in endonasal cranial base surgery, 1039
for exposure of petrous internal carotid
artery, 148, 148f
in transnasal approach to cervical spine,
1071
Sphenopalatine artery
anatomy of, 8, 9f, 143, 144f
endoscopic ligation of, 12-13, 13f-14f
with anterior ethmoid artery ligation, 10
complications of, 15-16, 15f, 16f
ligation of, 146-147, 146f-148f
failed, 149, 150f
Sphenopalatine block
endoscopic, 93-94
transpalatal, 94, 94f
Sphenopalatine foramen, 8-9, 9f, 143, 144f,
146-147, 147f
Sphincter pharyngoplasty, for
velopharyngeal incompetence, 783, 785,
786f
Spinal accessory nerve
anatomy of, 682-683, 682f
preservation of, in modifi ed radical neck
dissection, 697-698, 697f-698f
in selective neck dissection, 700-701, 700f
Splint(s). See also Stent(s).
acrylic
after juvenile angiofi broma surgery, 45,
46f
after reconstruction at cleft site, 788
after total maxillectomy, 81, 84f
septal, in septoplasty, 22, 22f
Silastic, after endonasal surgery, 1051
Spondylosis, cervical, 710, 710f
Squamous cell carcinoma. See also specifi c
anatomic site, e.g., Lip cancer.
of cervical esophagus, 474
of fl oor of mouth, 241-245, 243f-245f
of hard palate, 205-215
Squamous cell carcinoma (Continued)
of head and neck, 724, 724f
of larynx, 379. See also Laryngeal cancer.
laryngocele and, 342-343, 343f
of lip, 183-193
of soft palate, 199-202, 200f-202f
Squamous cell carcinoma in situ, 724
SS-A and SS-B antibodies, in Sjögren’s
syndrome, 491
Stab wounds, laryngeal, 350
Staging
of cervical esophageal cancer, 477, 477t
of hard palate cancer, 207
of head and neck cancer, 679, 680f, 688,
689f
of juvenile angiofi broma, 41, 42t
of laryngeal cancer, 379-380, 380t
of lip cancer, 184
of maxillary sinus tumor, 77, 78f
of temporal bone carcinoma, 1272-1273,
1274t
Stains, 630
Stapedectomy, 1193
complications of, 1203-1207, 1203f-1206f
conventional, 1196-1199, 1196f-1199f
laser-assisted, 1199-1200, 1200f-1201f
minus prosthesis (STAMP), 1193
perilymphatic fi stula after, 1207, 1224,
1224f
with prosthesis, 1192-1193, 1193f
revision, 1200-1202
Stapedial artery remnants, 1185, 1185f,
1205, 1206f
Stapedial footplate
abnormalities of, ossicular chain
reconstruction for, 1160-1161, 1160f
fl oating, as complication of stapes surgery,
1204
removal of, 1196
Stapedotomy, revision, 1200-1202
Stapes
abnormalities of, ossicular chain
reconstruction for, 1157-1158, 1159f,
1160, 1160f
congenital anomalies of, 1178, 1178f
surgical correction of, 1181-1182,
1181f-1182f
surgery on, timing of, 1177-1178
Stapes prosthesis, 1192-1193, 1193f
magnetic resonance imaging and, 1207
Robinson type, 1196, 1198, 1198f, 1199f
wire-piston, 1200, 1201f
Stapes refl ex testing, in facial nerve tumor,
1246
Staplers/stapling techniques, in
diverticulectomy, 464-465, 464f
Stenson’s duct, injury to, 881
Stent(s). See also Splint(s).
for anterior glottic stenosis, 365, 366f
for laryngeal stenosis, 361-362, 362f, 376
after laryngeal trauma repair, 353
after laryngopharyngoesophagectomy,
482
Merocel, after exostoses removal, 1103,
1104f
nasopharyngeal airway as, in choanal
atresia repair, 30, 31f
Silastic, in choanal atresia repair, 30, 31f
for stomal stenosis, 624
for tracheal stenosis, 606-607

Index
I-31
Volume 1: pages 1-718
Volume 2: pages 719-1410
Stereotactic radiosurgery
for acoustic neuroma, 1297
for facial nerve tumor, 1246, 1252-1253,
1253f
for glomus tumor, 1324-1325, 1325f
Sternocleidomastoid muscle
anatomy of, 681, 682f
in radical neck dissection, 693, 693f, 694
in selective neck dissection, 699-700, 699f
Sternocleidomastoid muscle fl ap, 757
Sternocleidomastoid myoperiosteal fl ap, for
augmentation of anterior cricoid ring
and cervical trachea, 371, 374f-375f,
608, 610-611, 610f-611f
Steroids. See Corticosteroids.
Stoma
creation of
in laryngopharyngoesophagectomy, 481
in laryngotracheal separation, 599
in total laryngectomy, 428, 429f
infection of, 585
stenosis of, 623-627, 625f-627f
Stomaplasty, 439
laser, for stomal stenosis, 624
Strangulation, 350, 352, 352f
Strap muscles
dissection of, in thyroid lobectomy, 547,
548f, 549
release of, 423, 424f
in laryngectomy, 398, 399f, 403, 404f
repositioning of, for tracheocutaneous
fi stula and depressed scar, 618-619,
618f-620f
Stricture, after
laryngopharyngoesophagectomy, 482
Stroboscopy, rigid, of vocal fold lesions, 304,
305
Styloid process, elongated, removal of,
195-197, 196f-197f
Subciliary approach, in orbital fl oor fracture
repair, 915, 917f, 918
Subdural abscess, in otitis media, 1234-1235
Subdural inlay graft
for endonasal skull base reconstruction,
993
for skull defect repair, 133-134, 134f
Subglottic stenosis
in children, 371, 375, 375f
surgical treatment of, 367, 370-375,
371f-375f
in Wegener’s granulomatosis, 604
Subglottis
anatomy and physiology of, 349, 350f, 357
recurrent respiratory papillomatosis on,
326
Sublabial transseptal choanal atresia repair,
31
Sublingual gland, ranula in, surgical
management of, 499-504, 500f-503f
Submandibular duct, marsupialization of, in
ranula surgery, 502, 503f
Submandibular gland
calculi in
imaging of, 506, 506f
removal of, 485, 486f, 487, 488
treatment of, 505
excision of, 505-509
endoscopic, 509
intraoral, 508-509
patient selection for, 505
Submandibular gland (Continued)
pearls and pitfalls in, 509
postoperative management of, 509
preoperative evaluation for, 505-506
in radical neck dissection, 692-693, 693f
transcervical, 506-508, 507f-508f
tumor of, in buccal space, 535
Submandibular incision, for prestyloid
parapharyngeal space tumor excision,
528-529, 528f, 529f
Submental incision, for rhytidectomy,
847-848, 848f
Submental-submandibular space, abscess in,
671, 672f
Subperiosteal abscess
of ear, 1082, 1082f
of forehead, 118, 118f
Subperiosteal pocket creation, in endoscopic
ligation of sphenopalatine artery, 12-13,
13f
Substernal goiter
computed tomography in, 545, 545f
surgery for, 551-552
Suction, for foreign body removal from ear,
1095, 1095f
Superfi cial musculoaponeurotic system
(SMAS), approximation of, 537-538
Superior orbital fi ssure syndrome, 908
Suprabullar cells, 92
surgery of, 94-95
Supracricoid partial laryngectomy with
cricohyoidoepiglottopexy, 403-408
overview of, 393-394
pearls and pitfalls in, 406, 408
postoperative care in, 406
preoperative evaluation in, 403
technique of, 403-406, 404f-407f, 404t
Supraglottic cancer, 388f-389f, 389
etiology of, 394
horizontal partial laryngectomy for,
393-409. See also Laryngectomy,
horizontal partial.
preoperative evaluation of, 396-398, 396f,
397f
therapeutic alternatives for, 394-395
Supraglottic laryngectomy
extended, 401-402, 409
overview of, 393
pearls and pitfalls in, 402-403
postoperative management of, 402
technique of, 398-402, 399f-402f, 399t
transcervical, 363, 363f, 364f
Supraglottic swallow, 402
Supraglottis
anatomy and physiology of, 349, 350f, 357
recurrent respiratory papillomatosis on,
325
stenosis of, surgical treatment of, 363,
363f, 364f
Suprahyoid pharyngotomy, 229-233
patient selection for, 230
pearls and pitfalls in, 233
postoperative management of, 231, 233
preoperative planning for, 230
technique of, 230-231, 231f-233f
Supratip depression, after septoplasty, 25
Sural nerve graft, for facial nerve repair,
521, 1252, 1252f, 1268
Suspension system, for microsuspension
laryngoscopy, 306, 384f, 385
Sutures
for facial soft tissue injuries, 872, 873f,
877-878
materials for, 876-877, 877t
types of, 873f
Swallowing
functional endoscopic examination of,
461, 461f
retraining of, after suprahyoid
pharyngotomy, 231, 233
after total glossectomy, 226-227
Sweating, gustatory, 495-498, 496f, 497f, 516
Swimming
exostoses associated with, 1099
after tympanostomy tube placement, 1129
Syndrome of inappropriate antidiuretic
hormone (SIADH), after anterior
cranial base surgery, 994
Synechia
after endoscopic maxillary sinus surgery,
55
interarytenoid, in posterior glottic
stenosis, 314, 315f
after intranasal ethmoidectomy, 102
Synkinesis, post-paralytic, 1386, 1386t
Syphilis, laryngeal stenosis in, 359, 359f
T
T tubes, 781, 1129, 1129f
Tarsorrhaphy
in anterior cranial base surgery, 985
temporary
in medial maxillectomy and lateral
rhinotomy, 69
in total maxillectomy, 80
Tearing correction, lacrimal surgery for,
967-972. See also Dacryocystorhinostomy.
Teeth. See Tooth (teeth).
Tefl on, for stapes prosthesis, 1193
Tefl on granuloma, 318f
Telecanthus, traumatic, 922-923, 925f
Telescope, in rigid bronchoscopy, 568, 570,
572
Temple, cancer on, 728, 732
Temporal artery, superfi cial, in anterior
cranial base surgery, 986
Temporal bone
arachnoid granulations of, 1359
cancer of. See Temporal bone carcinoma.
cerebrospinal fl uid leak through. See
Cerebrospinal fl uid otorrhea.
cholesterol granuloma and epidermoid
tumor of, 1337-1356
anatomy in, 1337-1338, 1338f
overview of, 1338-1341, 1340f
preoperative evaluation of, 1343-1344
radiologic imaging of, 1341-1343,
1341f-1343f, 1342t
surgical management of
complications of, 1354-1355
decision-making for, 1344-1346, 1344t
pearls and pitfalls in, 1356
postoperative care after, 1353-1354,
1354f
preauricular subtemporal
infratemporal approach in,
1351-1353, 1352f-1353f
retrofacial infralabyrinthine approach
in, 1348-1349, 1349f

I-32
Index
Volume 1: pages 1-718
Volume 2: pages 719-1410
Temporal bone (Continued)
techniques in, 1346-1353
transcanal infracochlear approach in,
1347-1348, 1347f-1348f
transcochlear approach in, 1350
translabyrinthine approach in,
1349-1350, 1349f
transnasal approach, 1353
tympanomastoid exteriorization in,
1350-1351, 1350f-1351f
tympanomeatal approach in,
1346-1347, 1346f
drilling of, mastoidectomy and, 1167
dural sinus and, relationship between,
1234f
fracture of, 1367-1375
cerebrospinal fl uid leak after, 1368
repair of, 1373-1374, 1373f
facial paralysis after, 1367-1368
longitudinal (otic capsule–sparing),
1367, 1368f, 1369
preoperative evaluation of, 1369, 1369f
signs and symptoms after, 1368t
surgery for
patient selection in, 1367-1369
pearls and pitfalls in, 1374-1375
postoperative care in, 1374, 1374f
techniques in, 1369-1374
transmastoid approach in, 1370-1371,
1371f-1372f
transmastoid-transepitympanic
approach in, 1370, 1370f, 1371,
1373f
transmastoid-translabyrinthine
approach in, 1371, 1373f
transverse (otic capsule–violating),
1367, 1368f, 1369, 1369f
glomus tumor of, 1319-1335. See also
Glomus tumor.
petrous apex of. See Petrous apex.
resection of
anesthesia for, 1279
complications of, 1289-1291
dural resection in, 1284
infratemporal resection in, 1284-1286,
1285f
jugular foramen dissection in,
1283-1284, 1284f
lateral, 1279-1282, 1279f-1282f
margins in, 1274-1276, 1275f
neck dissection with, 1276
parotidectomy with, 1276
patient selection for, 1276-1277, 1276f
pearls and pitfalls in, 1292
postoperative management of,
1287-1288, 1288f-1289f
premedications in, 1279
preoperative planning for, 1277-1279,
1277f-1278f
reconstruction after, 1286-1287, 1287f,
1288, 1289f
subtotal, 1282-1283, 1283f
techniques in, 1279-1287
total, 1286
styloid process of, elongated, 195-197,
196f-197f
trauma to, 1367-1375
cerebrospinal fl uid otorrhea from,
1360
hearing loss from, 1148, 1149f
Temporal bone (Continued)
tumor of, cerebrospinal fl uid otorrhea in,
1360
Temporal bone carcinoma, 1271-1292
adjuvant therapy for, 1276
anatomic considerations in, 1272, 1273f,
1274f
metastatic, detection of, 1278
radiologic imaging in, 1277-1278,
1277f-1278f
staging of, 1272-1273, 1274t
surgery for. See Temporal bone, resection
of.
therapeutic options for, 1273-1276
tumor types in, 1271-1272
Temporal craniotomy
in middle fossa approach, 1029, 1029f,
1030f, 1264, 1264f
orbitozygomatic osteotomy and, exposure
after, 1007f
in preauricular (subtemporal)
infratemporal fossa surgery, 1004,
1004f
in transpetrosal approach, 1034, 1035f
Temporal incision, for middle fossa
approach to petrous carotid artery,
1027, 1027f
Temporal lobe injury, in petrosal approach
to cranial base tumor, 1041-1042
Temporal muscle fl ap, for palatal
reconstruction, 86
Temporalis fascial graft, in dural defect
repair, 1363, 1363f, 1364, 1364f
Temporalis fl ap, 759-761, 760f
for cranial base reconstruction, 1062-1064,
1063f
in middle fossa approach to petrous
carotid artery, 1028-1029
for palatal defect repair, 213, 214f
Temporalis muscle
in anterior cranial base surgery, 987,
987f
in preauricular (subtemporal)
infratemporal fossa surgery, 1003-
1004, 1003f
transposition of
in anterior transfacial infratemporal
fossa surgery, 1014, 1016f
defect after, 1021, 1021f
in glomus tumor surgery, 1333, 1333f
for infratemporal skull base defect,
1007-1008, 1010f, 1011f
Temporal-subtemporal craniotomy, in
anterior transfacial infratemporal fossa
surgery, 1014, 1016f
Temporoparietal fascial fl ap, 758-759, 760f
for cranial base reconstruction, 1064,
1064f
Tensor tympani, in middle fossa approach
to petrous carotid artery, 1022f, 1031
Tetanus, prophylaxis against, in wound
management, 876t
Tetany, after thyroid surgery, 555
Tetracaine
for nasopharyngeal anesthesia, 295
for transnasal esophagoscopy, 446
for tympanic membrane anesthesia,
1076-1077
Thiersch graft, for canal defect after
exostoses removal, 1103, 1104f
Thigh fl ap
anterior, for esophageal reconstruction,
481
anterolateral, 745-746, 746f
for pharyngectomy defect, 746f, 748
Thoracic duct, anatomy of, 686, 686f
Thoracic esophagus, penetrating trauma to,
455, 455f
Thrombophlebitis, septic, of internal jugular
vein, 674, 674f, 676-677
Thrombosis
deep vein
after anterior cranial base surgery, 995
after petrosal approach to cranial base
tumor, 1042
prophylaxis against, in anterior cranial
base surgery, 984
lateral sinus, in otitis media, 1233,
1234f-1235f
Thyroarytenoid-lateral cricoarytenoid muscle
complex
electromyography of, in bilateral vocal
fold immobility/paralysis, 311
localization and Botox injection of, 294,
295f
Thyroglossal duct cyst, 635-642
carcinoma arising in, 636-637, 636f
differential diagnosis of, 635
epidemiology of, 635-636
palpation of, 637, 637f
pearls and pitfalls in, 641-642
recurrence of, 641, 641f, 642f
surgical excision of
complications of, 641, 641f, 642f
patient selection for, 636-637, 636f, 637f
postoperative management after,
640-641
preoperative planning for, 637-638, 638f
technique for, 638-640, 640f-641f
Thyroglossal tract remnants, 640, 640t
Thyrohyoid approach, in percutaneous
(transcervical) vocal fold augmentation,
297-298, 298f, 299
Thyroid artery
inferior, in parathyroidectomy, 561, 561f
superior
anatomy of, 685
dissection of, in thyroid lobectomy,
549f, 550
Thyroid cancer
airway invasion by, 551
in children, 542
clinical evaluation for, 544-546, 545f-546f
fi ndings in, 541-542, 542f, 543-544, 543f
metastasis of
cervical, 543, 552-553, 553f
distant, 553, 553f
prognosis in, 543
surgical management of. See Thyroid
surgery.
thyroglossal duct cyst and, 638
Thyroid cartilage
division of, in supraglottic laryngectomy,
399, 400f
trauma to, 352, 352f, 354
Thyroid gland, developmental anatomy of,
635
Thyroid lobectomy, 547-550, 548f-549f
Thyroid neoplasm, fi ne-needle aspiration
biopsy of, 544-545, 630, 631t

Index
I-33
Volume 1: pages 1-718
Volume 2: pages 719-1410
Thyroid nodule, solitary, 541, 542f, 544-545,
545f
Thyroid surgery, 541-555
anesthesia for, 546
cervical incision in, 546-547, 547f
complications of, 553-555
neck dissection in, 543, 552-553, 553f
patient selection for, 541-544, 542f-543f
pearls and pitfalls in, 555
postoperative management of, 553
preoperative evaluation for, 544-546,
545f-546f
for substernal goiter, 551-552
thyroid lobectomy in, 547-550, 548f-549f
thyroidectomy in
endoscopic, 552
total, 550-551
Thyroiditis, chronic, 551
Thyroplasty, type I. See Laryngoplasty,
medialization.
Thyrotomy
lateral, for laryngocele excision, 344-346,
345f
median. See Laryngofi ssure.
Tics, 1386t
Tinnitus, pulsatile, in otosclerosis, 1189
Tip, nasal. See Nasal tip surgery.
Tissue adhesives, cyanoacrylate, for facial
repair and reconstruction, 877
Titanium
for ossicular chain prosthesis, 1151,
1151f
for stapes prosthesis, 1193
Titanium burr hole covers, in anterior
cranial base reconstruction, 991, 991f
Titanium mesh
for craniofacial skeleton reconstruction,
1064, 1066f
for orbital reconstruction, 943, 1064-1065,
1067f
Titanium microplates
in anterior cranial base reconstruction,
991
in craniofacial skeleton reconstruction,
1064, 1065f
Tongue
enlarged. See Macroglossia.
epidermal cyst of, 163f
neurofi broma of, 162, 162f, 165, 165f
palpation of, 219, 220f
Tongue base
suturing of, after supraglottic
laryngectomy, 401, 401f
tumor of, excision of
lateral pharyngotomy for, 235-240. See
also Pharyngotomy, lateral.
mandibulectomy for, 229
mandibulotomy for, 229
suprahyoid pharyngotomy for, 229-233.
See also Suprahyoid pharyngotomy.
Tongue cancer, 217-227
deviation of tongue in, 219, 219f
endophytic versus exophytic, 219, 219f
metastasis of, 217, 218, 219-220, 220f
neck dissection in, 218, 226
partial glossectomy for, 218-223, 219f-222f
postoperative management of, 226-227
total glossectomy for, 223-226, 223f-225f
treatment principles for, 217-218
tumor thickness in, 219, 219f
Tongue fl ap, for palatal repair, 213, 787
Tongue-in-groove technique, in rhinoplasty,
817
Tongue-splitting approach, midline,
mandibulotomy with, 280, 281f
Tonsil
lymphoma of, 283, 284f
metastasis to, 283, 284f
pharyngeal. See Adenoid(s).
Tonsillectomy, 169-180
adenoidectomy with, 33-34, 35, 170, 174
complications of, 178-179
hemostasis using electrocautery for, 173,
176
indications for, 170, 171, 171t
for obstructive sleep apnea, 177
overview of, 169-170, 170f
patient positioning for, 173, 174f
patient selection for, 171, 171t
in patients with cleft palate, 782-783
pearls and pitfalls in, 180
for peritonsillar abscess, 177-178
postoperative care in, 178
procedure for, 173-176, 175f-176f
quality of life after, 176-177
quinsy, 178
types of procedures for, 172-173, 172t
uvulopalatopharyngoplasty and, 153, 153f
Tooth (teeth)
extraction of
in marginal mandibulectomy, 259, 259f
oral-antral fi stula after, 63, 64-65, 64f,
65f-66f
fracture of, 889-890
injury to, in phonomicrosurgery, 309
numbering system and descriptions of,
885, 886f
rehabilitation of, after marginal
mandibulectomy, 256, 257f, 258f
TORP (total ossicular replacement
prosthesis), 1147, 1148, 1148f, 1158,
1159f, 1160, 1160f
Toxic shock syndrome, after septoplasty, 24
Trachea
identifi cation of, in thyroid lobectomy,
548f, 549
penetrating injury to, management of,
455, 455f
resection of
in cervical esophageal cancer surgery,
478
and end-to-end anastomosis, for
tracheal stenosis, 611-613, 611f,
612f
Tracheal stenosis, 603-614, 605, 605f. See also
Laryngeal stenosis.
clinical evaluation of, 604-605, 604f
complications of, 613
defi nition of, 623
dilatation for, 606
endoscopic microsurgery for, 607, 607f
imaging of, 605, 605f
laryngotracheal reconstruction with
cartilage autografts for, 608, 608f,
609f
pathogenesis of, 603-604
pearls and pitfalls in, 614
postoperative management of, 613
resection and end-to-end anastomosis for,
611-613, 611f, 612f
Tracheal stenosis (Continued)
stenting for, 606-607
sternocleidomastoid myoperiosteal fl ap
for, 608, 610-611, 610f-611f
surgical techniques for, 605-613
after tracheostomy, 585
transcervical procedures for, 607-608, 607f
Tracheal suctioning
after mouth fl oor cancer excision, 247
technique of, 582
Tracheobronchial anatomy, 565, 566f
Tracheobronchial foreign body, removal of,
bronchoscopy for, 573-574, 573f, 573t,
574f
Tracheobronchitis, after tracheostomy, 585
Tracheocutaneous fi stula, after
tracheostomy, 617-621, 618f-620f
Tracheoesophageal fi stula, tracheostomy
and, 583, 585
Tracheoesophageal puncture
contraindications to, 433
after laryngotracheal separation, 596
one-way valve used in, 432, 432f
patient selection for, 432-433
pearls and pitfalls in, 437
postoperative care after, 437, 437f
preoperative evaluation for, 433-434
primary, 434, 434f
role of speech-language pathologist in,
432
secondary, 434-437, 435f-436f
surgical closure of, 439-441, 440f
in total laryngectomy, 427
Tracheolaryngeal separation. See
Laryngotracheal separation.
Tracheomalacia, after tracheostomy, 585
Tracheoscopy, 565-575, 569t. See also
Bronchoscopy.
in cervical esophageal cancer, 477
Tracheostoma. See Stoma.
Tracheostomy, 577-593
accidental extubation in, 592
complications of, 583-585
immediate postoperative, 584-585
intraoperative, 583-584, 583f
late postoperative, 585, 586f
decannulation in, 582-583
accidental, 592
in glottic enlargement surgery, 312
historical background on, 577
before oropharyngeal cancer excision, 285
in partial glossectomy, 221
patient selection for, 578, 578f
pearls and pitfalls in, 593
percutaneous dilatational, 585-593,
588f-591f
anesthesia for, 587
complications of, 591-592
instruments for, 587, 588f
patient selection for, 586-587
personnel for, 587
postoperative considerations in, 590-591
technique of, 587-590, 588f-590f
postoperative care in, 582-583
preoperative planning for, 578
after supraglottic laryngectomy, 401, 402f
surgical technique for, 579-581, 580f-581f
in total laryngectomy, 428
tracheocutaneous fi stula and depressed
scar after, 617-621, 618f-620f