Sternberg's canal as historically defined is not nearly as prevalent as previously reported. Furthermore, the presence of arachnoid pits in all sphenoid CSF leaks and the predominant leak location lateral to the sites of fusion of ossification centers suggests that the leaks are acquired. Contributing factors may include arachnoid pits/weaknesses in the skull base and intracranial hypertension.

BACKGROUND Tracheomalacia (TM) occurs in approximately 1 in 2,100 children. Because the trachea develops abnormally in animal models of cystic fibrosis (CF), we hypothesized this may also occur in children with CF, increasing their risk of TM. PURPOSE To examine the prevalence and clinical consequences of TM in children with CF. METHODS We studied children with CF born between 1995 and 2012. TM was defined as dynamic collapse of the trachea, and the severity was recorded as described in the chart. The effect of TM on patient outcomes, including FEV1, CT changes, and acquisition of CF pathogens, was assessed using a longitudinal patient dataset. RESULTS 89% of children with CF had at least one bronchoscopy (n = 97/109). 15% of these children had TM described in any bronchoscopy report (n= 15/97). Of the patients with TM, 8 had meconium ileus (p = 0.003) and all were pancreatic insufficient. Pseudomonas aeruginosa infection occurred 1.3 years earlier among children with TM (p = 0.01). Starting FEV1 values by age 8 were diminished by over 18% of predicted for patients with TM. Life-threatening episodes of airway obstruction occurred in 3 of 15 patients with CF and TM, including one leading to death. Gender, prematurity, and hepatic disease were not associated with TM. No difference was observed in the frequency of bronchiectasis. CONCLUSIONS TM is significantly more common in infants and children with CF than in the general population and is associated with airway obstruction and earlier Pseudomonas acquisition.

Fistula formation remains a significant cause of morbidity associated with hypopharyngeal-reconstruction. Postoperative course and successful preventive strategies are discussed.

Objective To investigate the effect of subtotal petrosectomy and mastoid obliteration (SPMO) on the overall success of adult and pediatric cochlear implant (CI) recipients. Study Design Retrospective Case Series Setting Tertiary Care Referral Center Patients 39 ears in 36 patients (23 adults and 13 children) received both surgeries between 1990 and 2012. Intervention CI candidates underwent SPMO to permit implantation and minimize the risks of infectious complications in the recipient ear. SPMO was performed prior to (69.3%), at the time of (25.6%) and after CI (5.13%). Mastoids were obliterated with fat (30.8%), muscle (66.7%), and bone pate (2.56%). Main Outcome Measure Feasibility, complications and success of SPMO and CI were assessed with standard statistical analysis and Fischer's Test with Two Sided P –Values. Results Ear disease was definitively managed and CI was successfully placed in all but one case. Complications including abscess (n=3), subcutaneous emphysema (n=1), ear canal granulation formation (n=1) and electrode extrusion (n=1) occurred in 15.4% of patients. Predisposing syndromes were present in children more often than adults (43.8% vs 13.0%, p=0.0598). Adults more often than children had previous mastoid surgery for middle ear disease (30.4% vs 0.0% p=0.0288). CIs were placed under local anesthetic and sedation (n=3) and after radiation treatment for nasopharyngeal cancer (n=2) in adult ears. Conclusions SPMO is an effective and safe procedure for definitively managing middle ear disease and implanting adult and pediatric CI candidates.

In order to evaluate the Dynasplint Trismus System (DTS) for the relief of trismus secondary to the treatment of head and neck cancer, we conducted a retrospective chart review of patients who had undergone DTS therapy during a 1-year period. Our inclusion criteria were cancer of the upper aerodigestive tract; treatment with radiation, chemotherapy, and/or surgery; and a maximal incisal opening (MIO) of less than 30 mm. MIO and the rate of improvement of trismus ("gain") were measured at selected intervals. Twenty-six patients met our study criteria; their pretherapy mean MIO was 19.3 mm. At the time of their most recent measurement, the mean MIO had increased to 25.5 mm-a measured gain of 32%. Although the initial rate of gain was 0.36 mm/day during the fi rst 6 weeks, improvement leveled off over time, and the overall rate of gain was 0.16 mm/day. We conclude that the DTS is eff ective in increasing the mandibular range of motion at a rate of change that is maximized during initial treatment.