Literature Review: A Roundup of Important Recent Studies

Reference: Ward BK, Agrawal Y, Nguyen E, et al. Hearing outcomes after surgical plugging of the superior semicircular canal by a middle cranial fossa approach. Otol Neurotol. 2012;33(8):1386-1391.

—Reviewed by George Hashisaki, MD

Vocal Fold Paresis Following Neonatal Cardiac Surgery

What are the incidence and implications of vocal fold paresis (VFP) following congenital neonatal cardiac surgery?

Background: VFP and post-operative feeding difficulties are known complications of cardiac surgery in children, particularly in association with aortic arch interventions, the intra-operative use of transesophageal echocardiography, low birth weight, median sternotomy, use of electrocautery or prolonged intubation. Manipulation of the aortic arch places the recurrent laryngeal nerve and, thus, vocal fold function at risk.

Study design: Retrospective chart review.

Setting: Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston; Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston.

Synopsis: Previous studies noted in this article indicate a range of 1.7 percent to 67 percent for reported incidence of VFP following cardiac surgery. Of 76 neonates who underwent a median sternotomy for cardiac surgery between May 2007 and May 2008, 19.7 percent had VFP post-operatively. Almost 27 percent of the patients with aortic arch surgery had VFP, while only 4.1 percent of the patients with nonaortic arch surgery developed VFP. Patients who underwent aortic arch surgery weighed significantly less and all patients with VFP had significant morbidity related to swallowing and nutrition, requiring longer post-surgical hospitalization. The researchers did not find that post-operative VFP was associated with significantly longer intubation times. Their cohort included patients with a wide variety of complex cardiac operations, in comparison with previous studies in which a difference in intubation time was noted, which included patients who underwent patent ductus arteriosus ligation.

Bottom line: The reported incidence of VFP following cardiac surgery via median sternotomy ranges between 1.7 percent and 67 percent, depending on the type of surgery and weight of the infant. In this study, surgery requiring aortic arch manipulation had a higher incidence of complications and required longer hospitalizations.

Reference: Dewan K, Cephus C, Owczarzak V, Ocampo E. Incidence and implication of vocal fold paresis following neonatal cardiac surgery. Laryngoscope. 2012;122(12):2781-2785.

—Reviewed by Sue Pondrom

Management of Temporal Bone Defects after Oncologic Resection

What is the best way to manage defects resulting from oncologic temporal bone resection?

Background: There are limited reports regarding use of local and regional flaps versus microvascular free flaps for temporal bone reconstruction after oncologic resection. Additionally, outcomes are only sporadically documented for facial nerve repair and rehabilitation in the oncologic setting after resection.