This study was performed to review our experience with deep neck abscesses (DNAs) and compare it to the experiences in the available literature, and to study changing trends within our patient population. We retrospectively studied 210 patients who had DNAs between 1981 and 1998. Peritonsillar abscesses and limited intraoral abscesses were excluded. Demographics, presentation, etiology, site of abscess, associated systemic diseases, bacteriology, radiology, treatment, airway management, and outcome were reviewed. We compared the entire group to those in the available literature and studied changing trends within this patient population. Dental infection (43%) was the most common cause, followed by intravenous drug abuse (12%) and pharyngotonsillitis (6%). The incidences of intravenous drug abuse and mandibular fractures as causes of DNA were 19% and 8%, respectively, during the period 1981 to 1990, but were only 1% each during the period 1991 to 1998. Streptococcus viridans was the most common pathogen (39% of positive cultures), followed by Staphylococcus epidermidis (22%) and Staphylococcus aureus (22%). Lateral pharyngeal space abscess was the most common DNA (43%), followed by submandibular space abscess, Ludwig's angina, and retropharyngeal space abscess (28%, 17%, and 12%, respectively). Seventy-five percent of patients with true Ludwig's angina underwent tracheotomy. Nondental infections are no longer a significant etiologic factor in DNA. Streptococcus viridans has replaced S aureus and beta-hemolytic streptococci as the most common pathogen. Lateral pharyngeal space abscess was the most common DNA; however, its incidence has progressively decreased over the past decade. Intravenous drug abuse and mandibular fractures are no longer major etiologic factors. Tracheotomy is indicated in patients with Ludwig's angina.

Based on our series, the intraoral technique with a midline incision avoiding disruption of the mentalis muscle is recommended for its ease, simplicity, patient satisfaction, low complication rate, and circumvention of an external scar. The external approach should be considered in cases that require a very large implant.

FOE is an invaluable tool in the assessment of the compromised airway in patients with angioneurotic edema Laryngeal edema alone is an ominous physical finding. When laryngeal and pharyngeal edema are present together, the physician should consider immediate intervention. Our findings indicate that symptoms, including stridor, hoarseness, and dysphagia, do correlate with disease severity; however, they must be confirmed with fiberoptic visualization. Although sound clinical judgment should always be exercised, we present our results in the management of the acute airway in angioneurotic edema.

Hydroxyapatite cement (HAC) is a calcium phosphate cement whose properties overcome the inherent limitations of previous forms of hydroxyapatite. HAC (BoneSource, Leibinger Corp., Dallas, TX) is prepared as a powder that forms an easily applicable paste which hardens in six to 20 minutes. HAC exhibits excellent biocompatibility, is easily contoured in situ, is highly stable, and allows osteoconduction. The use of calcium phosphate cements (CPC) for reconstruction of craniofacial defects has intrinsic appeal owing to the chemical and physical properties of hydroxyapatite. Difficulty in contouring CPC implants, their lack of compressive strength, and their failure to allow osteoinduction were significant limitations in the use of earlier forms of hydroxyapatite for skeletal reconstruction. HAC offers an excellent reconstructive option for repair of various craniofacial defects.

The pericranial flap is a vascularized local flap that is easily harvested. The use of the pericranial flap avoids donor site morbidity associated with free fat or cancellous bone grafts. The pericranial flap arms the head and neck surgeon with an effective alternative to other methods of frontal sinus obliteration.

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Research Forum-Monday P99 the RDI (R = 0.43) and the adenoid size (R = 0.43). Two items with poor validity were dropped, reducing the survey to 18 items (OSA-18). The relationship between the OSA-18 summary score and RDI remained significant when adjusted for tonsil size, adenoid size, body mass index, and child age. Based on the total survey score the impact of OSAS on quality of life was small for 20 children (33%), moderate for 19 (31%), and large for 22 (36%). Conclusions: The OSA-18 is a valid and reliable measure of disease-specific quality of life in children with OSAS. Future studies are needed to assess the responsiveness of the survey to clinical change within patients.

Patients who are satisfied with their initial decision to undergo surgery are most likely to comply with planned therapy. Conversely, patients who score <4.0 on the SWD scale may benefit from additional preoperative counseling to increase the likelihood of compliance.